The Posterior Cerebral Circulation Based On Dynamic CTA To Guide Reperfusion Therapy In Patients With Acute Basilar Artery Occlusion

Objectives:To study posterior circulation collateral status based on dynamic CTA reconstruction with CTP in patients with ischemic stroke caused by acute basilar artery occlusion(BAO),and further analyzes the influence between collateral circulation and near and long-term outcome.Methods:We retrospectively reviewed acute ischemic stroke patients with basilar artery occlusion from January 2012 to December 2016 undergoing reperfusion treatment in our stroke center including clinical baseline characteristics,laboratory results,imaging examination and prognosis evaluation after 3 months.Good outcome was defined as a modified Rankin Scale(mRS)0?3 at 3 months after stroke.Dynamic CT angiography(dCTA)was performed according to CT perfusion imaging,then the posterior circulation collateral score(PC-CS)was reconstructed,and analyzed the correlation between the posterior circulation collateral score(PC-CS)and hemorrhagic transformation,recanalization and 3 months good outcome.Univariate and two logistic regression analyses were performed to analyze the risk factors of hemorrhagic transformation,recanalization and good prognosis after 3 months.Results:Totally 47 patients treated with reperfusion were enrolled in the analysis.Univariate analysis revealed that good prognosis as dependent variable,multivariate regression analysis suggested that PC-CS was an independent predictor of good outcome at 3 months(OR=1.967,95%CI 1.028?3.765,P=0.041),and PC-CS 4.5 was the best threshold to predict good outcome(AUC:0.846,sensitivity of 69.6%,specificity of 87.5%).The results showed that fibrinogen was a protective factor for hemorrhagic transformation(OR=0.016,95%CI 0?0.691,P=0.031),and the baseline NIHSS and PC-CS were not.The results showed that PC-CS(OR=1.655,95%CI 1.013?2.703,P=0.044)and diabetes(OR=0.057,95%CI 0.004?0.787,P=0.032)were the independent predictors of recanalization.Conclusions:Dynamic CTA,based on CT perfusion imaging can be used to evaluate collaterals in posterior circulation,which can predict 3-months good clinical outcome and recanalization after reperfusion therapy in patients with acute basilar artery occlusion.