The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion

Author:

Alemseged Fana1,Shah Darshan G.1,Diomedi Marina1,Sallustio Fabrizio1,Bivard Andrew1,Sharma Gagan1,Mitchell Peter J.1,Dowling Richard J.1,Bush Steven1,Yan Bernard1,Caltagirone Carlo1,Floris Roberto1,Parsons Mark W.1,Levi Christopher R.1,Davis Stephen M.1,Campbell Bruce C.V.1

Affiliation:

1. From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and...

Abstract

Background and Purpose— Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the Basilar Artery on Computed Tomography Angiography (BATMAN) score. Methods— A retrospective analysis of consecutive stroke patients with basilar artery occlusion diagnosed on computed tomographic angiography was performed. BATMAN score is a 10-point computed tomographic angiography–based grading system which incorporates thrombus burden and the presence of collaterals. Reliability was assessed with intraclass coefficient correlation. Good outcome was defined as modified Rankin Scale score of ≤3 at 3 months and successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMAN score was externally validated and compared with the Posterior Circulation Collateral score. Results— The derivation cohort included 83 patients with 41 in the validation cohort. In receiver operating characteristic (ROC) analysis, BATMAN score had an area under receiver operating characteristic curve of 0.81 (95% confidence interval [CI], 0.7–0.9) in derivation cohort and an area under receiver operating characteristic curve of 0.74 (95% CI, 0.6–0.9) in validation cohort. In logistic regression adjusted for age and clinical severity, BATMAN score of <7 was associated with poor outcome in derivation cohort (odds ratio, 5.5; 95% CI, 1.4–21; P =0.01), in validation cohort (odds ratio, 6.9; 95% CI, 1.4–33; P =0.01), and in endovascular patients, after adjustment for recanalization and time to treatment (odds ratio, 4.8; 95% CI, 1.2–18; P =0.01). BATMAN score of <7 was not associated with recanalization. Interrater agreement was substantial (intraclass coefficient correlation, 0.85; 95% CI, 0.8–0.9). BATMAN score had greater accuracy compared with Posterior Circulation Collateral score ( P =0.04). Conclusions— The addition of collateral quality to clot burden in BATMAN score seems to improve prognostic accuracy in basilar artery occlusion patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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