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Utility of digital subtraction angiography‐based collateral evaluation in medically treated acute symptomatic basilar artery stenosis
Author(s) -
Lee W.J.,
Jung K.H.,
Ryu Y. J.,
Kim J.M.,
Lee S.T.,
Chu K.,
Kim M.,
Lee S. K.,
Roh J.K.
Publication year - 2017
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13351
Subject(s) - medicine , digital subtraction angiography , modified rankin scale , basilar artery , neuroradiology , interquartile range , stroke (engine) , radiology , collateral circulation , stenosis , posterior cerebral artery , angiography , posterior inferior cerebellar artery , cardiology , middle cerebral artery , neurology , vertebral artery , ischemic stroke , ischemia , mechanical engineering , psychiatry , engineering
Background and purpose Although a stroke from atherosclerosis in the basilar artery ( BA ) often presents with mild initial stroke severity, it has heterogeneous clinical courses. We investigated the efficacy of digital subtraction angiography ( DSA )‐based collateral perfusion evaluation in association with long‐term outcomes of medically treated symptomatic basilar artery stenosis. Methods From a registry database of all consecutive patients with stroke, we included 98 medically treated patients (due to mild initial stroke severity) [National Institute of Health Stroke Scale ( NIHSS ) scores ≤ 4; symptomatic basilar artery stenosis, 70–99%] with available initial diagnostic DSA . Basilar collateral scoring was performed via the DSA , using a modified version of the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system in both the superior cerebellar artery and anterior/posterior‐inferior cerebellar artery territories (score 0–8). The outcomes were designated as the 90‐day modified Rankin Scale ( mRS 90) score (poor, 3–6). Student's t ‐test, chi‐square test and logistic regression analyses were used to identify factors associated with a poor outcome. Results The median initial NIHSS score was 2 [interquartile range ( IQR) , 0–3], median posterior circulation Alberta Stroke Program Early CT Score was 8 (IQR, 7–10), median collateral score was 7 (IQR, 7–8) and 20 (20.4%) had poor mRS 90 scores. In multivariate analysis, poorer collateral scores ( P = 0.003), higher NIHSS scores ( P = 0.005) and lower posterior circulation Alberta Stroke Program Early CT Score ( P = 0.017) were independently associated with a poor mRS 90 score. Conclusions The DSA ‐based collateral scoring of the BA large branches might predict long‐term outcome in medically treated symptomatic basilar artery stenosis with mild initial severity. Evaluation of BA collateral perfusion status might be useful to determine appropriate treatment strategies.