Cong Luo, Thanh N Nguyen, Rui Li, Chunrong Tao, Xiaozhong Jing, Li Wang, Anmo Wang, Yuyu Zhou, Feiyang Gao, Keyi Zhang, Raul G Nogueira, Wei Hu
{"title":"计算机断层灌注参数：基底动脉闭塞治疗选择的潜在工具。","authors":"Cong Luo, Thanh N Nguyen, Rui Li, Chunrong Tao, Xiaozhong Jing, Li Wang, Anmo Wang, Yuyu Zhou, Feiyang Gao, Keyi Zhang, Raul G Nogueira, Wei Hu","doi":"10.1002/ana.27214","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the association between computed tomography perfusion (CTP) parameters and outcomes in basilar artery occlusion (BAO), and to select patients with BAO who may benefit from thrombectomy.</p><p><strong>Methods: </strong>We performed a post-hoc analysis of patients from the ATTENTION trial with available admission CTP data. CTP parameters evaluated included time to maximum (T<sub>max</sub>) >6 s/8 s/10 s, relative cerebral blood flow (rCBF) <20%/30%/34%/38%/50%, Critical Area Perfusion Score (CAPS), and CTP-posterior circulation acute stroke prognosis early computed tomography score (CTP-pc-ASPECTS), pons-midbrain-thalamus (PMT) hypoperfusion. Multivariable Firth logistic regression was used to analyze associations between CTP parameters and outcomes and to explore treatment interactions. The primary outcome was favorable outcome, defined as modified Rankin Scale score of 0-3, at 90 days.</p><p><strong>Results: </strong>The study included 109 patients (70 thrombectomy, 39 control). Multivariable analysis showed that lower CAPS, smaller rCBF <34% volume, and higher CTP-pc-ASPECTS were associated with favorable outcome. Patients who underwent thrombectomy had a higher likelihood of favorable outcome with increasing CAPS (T<sub>max</sub> > 6 s) compared to control (P<sub>interaction</sub> = 0.048 for continuous variable). When CAPS (T<sub>max</sub> > 6 s) was treated as a categorical variable, the interaction remained significant (P<sub>interaction</sub> = 0.03). Similarly, the treatment effect was also modified by PMT hypoperfusion (T<sub>max</sub> >6 s) (P<sub>interaction</sub> = 0.03). In patients with CAPS (T<sub>max</sub> >6 s) >3 or with PMT hypoperfusion (T<sub>max</sub> >6 s), thrombectomy was associated with favorable outcome.</p><p><strong>Interpretation: </strong>Higher CAPS correlated with a decrease in the rate of favorable outcomes. However, patients with higher CAPS were more likely to benefit from thrombectomy compared to medical management alone, suggesting that severe hypoperfusion should not preclude endovascular treatment. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1000,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Computed Tomography Perfusion Parameters: A Potential Tool for Treatment Selection in Basilar Artery Occlusion.\",\"authors\":\"Cong Luo, Thanh N Nguyen, Rui Li, Chunrong Tao, Xiaozhong Jing, Li Wang, Anmo Wang, Yuyu Zhou, Feiyang Gao, Keyi Zhang, Raul G Nogueira, Wei Hu\",\"doi\":\"10.1002/ana.27214\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to evaluate the association between computed tomography perfusion (CTP) parameters and outcomes in basilar artery occlusion (BAO), and to select patients with BAO who may benefit from thrombectomy.</p><p><strong>Methods: </strong>We performed a post-hoc analysis of patients from the ATTENTION trial with available admission CTP data. CTP parameters evaluated included time to maximum (T<sub>max</sub>) >6 s/8 s/10 s, relative cerebral blood flow (rCBF) <20%/30%/34%/38%/50%, Critical Area Perfusion Score (CAPS), and CTP-posterior circulation acute stroke prognosis early computed tomography score (CTP-pc-ASPECTS), pons-midbrain-thalamus (PMT) hypoperfusion. Multivariable Firth logistic regression was used to analyze associations between CTP parameters and outcomes and to explore treatment interactions. The primary outcome was favorable outcome, defined as modified Rankin Scale score of 0-3, at 90 days.</p><p><strong>Results: </strong>The study included 109 patients (70 thrombectomy, 39 control). Multivariable analysis showed that lower CAPS, smaller rCBF <34% volume, and higher CTP-pc-ASPECTS were associated with favorable outcome. Patients who underwent thrombectomy had a higher likelihood of favorable outcome with increasing CAPS (T<sub>max</sub> > 6 s) compared to control (P<sub>interaction</sub> = 0.048 for continuous variable). When CAPS (T<sub>max</sub> > 6 s) was treated as a categorical variable, the interaction remained significant (P<sub>interaction</sub> = 0.03). Similarly, the treatment effect was also modified by PMT hypoperfusion (T<sub>max</sub> >6 s) (P<sub>interaction</sub> = 0.03). In patients with CAPS (T<sub>max</sub> >6 s) >3 or with PMT hypoperfusion (T<sub>max</sub> >6 s), thrombectomy was associated with favorable outcome.</p><p><strong>Interpretation: </strong>Higher CAPS correlated with a decrease in the rate of favorable outcomes. However, patients with higher CAPS were more likely to benefit from thrombectomy compared to medical management alone, suggesting that severe hypoperfusion should not preclude endovascular treatment. 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Computed Tomography Perfusion Parameters: A Potential Tool for Treatment Selection in Basilar Artery Occlusion.
Objective: This study aimed to evaluate the association between computed tomography perfusion (CTP) parameters and outcomes in basilar artery occlusion (BAO), and to select patients with BAO who may benefit from thrombectomy.
Methods: We performed a post-hoc analysis of patients from the ATTENTION trial with available admission CTP data. CTP parameters evaluated included time to maximum (Tmax) >6 s/8 s/10 s, relative cerebral blood flow (rCBF) <20%/30%/34%/38%/50%, Critical Area Perfusion Score (CAPS), and CTP-posterior circulation acute stroke prognosis early computed tomography score (CTP-pc-ASPECTS), pons-midbrain-thalamus (PMT) hypoperfusion. Multivariable Firth logistic regression was used to analyze associations between CTP parameters and outcomes and to explore treatment interactions. The primary outcome was favorable outcome, defined as modified Rankin Scale score of 0-3, at 90 days.
Results: The study included 109 patients (70 thrombectomy, 39 control). Multivariable analysis showed that lower CAPS, smaller rCBF <34% volume, and higher CTP-pc-ASPECTS were associated with favorable outcome. Patients who underwent thrombectomy had a higher likelihood of favorable outcome with increasing CAPS (Tmax > 6 s) compared to control (Pinteraction = 0.048 for continuous variable). When CAPS (Tmax > 6 s) was treated as a categorical variable, the interaction remained significant (Pinteraction = 0.03). Similarly, the treatment effect was also modified by PMT hypoperfusion (Tmax >6 s) (Pinteraction = 0.03). In patients with CAPS (Tmax >6 s) >3 or with PMT hypoperfusion (Tmax >6 s), thrombectomy was associated with favorable outcome.
Interpretation: Higher CAPS correlated with a decrease in the rate of favorable outcomes. However, patients with higher CAPS were more likely to benefit from thrombectomy compared to medical management alone, suggesting that severe hypoperfusion should not preclude endovascular treatment. ANN NEUROL 2025.
期刊介绍：
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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