Introduction

The Critical Area Perfusion Score (CAPS) predicts functional outcomes in vertebrobasilar thrombectomy patients based on computed tomography perfusion (CTP) hypoperfusion. We compared CAPS to the clinical-radiographic Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS).

Methods

Acute basilar thrombosis patients from January 2017–December 2021 were included in this retrospective analysis from a health system's stroke registry. Inter-rater reliability was assessed for 6 CAPS raters. A logistic regression with CAPS and CLEOS as predictors was performed to predict 90-day modified Rankin Scale (mRS) score 4-6. Area under the curve (AUC) analyses were performed to evaluate prognostic ability.

Results

55 patients, mean age 65.8 (± 13.1) years and median NIHSS score 15.5^5–24, were included. Light's kappa among 6 raters for favorable versus unfavorable CAPS was 0.633 (95% CI 0.497–0.785). Increased CLEOS was associated with elevated odds of a poor outcome (odds ratio (OR) 1.0010, 95% CI 1.0007–1.0014, p<0.01), though CAPS was not (OR 1.0028, 95% CI 0.9420–1.0676, p=0.93). An overall favorable trend was observed for CLEOS (AUC 0.69, 95% CI 0.54–0.84) versus CAPS (AUC 0.49, 95% CI 0.34–0.64; p=0.051). Among 85.5% of patients with endovascular reperfusion, CLEOS had a statistically higher sensitivity than CAPS at identifying poor 90-day outcomes (71% versus 21%, p=0.003).

Conclusions

CLEOS demonstrated better predictive ability than CAPS for poor outcomes overall and in patients achieving reperfusion after basilar thrombectomy.

中文翻译：

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夏洛特大动脉闭塞血管内治疗结果评分优于关键区域灌注评分用于基底血栓切除术前的预后

介绍

关键区域灌注评分 (CAPS) 根据计算机断层扫描灌注 (CTP) 灌注不足预测椎基底动脉血栓切除术患者的功能结果。我们将 CAPS 与临床影像学夏洛特大动脉闭塞血管内治疗结果评分 (CLEOS) 进行了比较。

方法

2017 年 1 月至 2021 年 12 月的急性基底动脉血栓形成患者被纳入这项来自卫生系统卒中登记的回顾性分析。对 6 名 CAPS 评分者评估了评分者间的可靠性。执行以 CAPS 和 CLEOS 作为预测因子的逻辑回归来预测 90 天改良 Rankin 量表 (mRS) 评分 4-6。进行曲线下面积 (AUC) 分析以评估预后能力。

结果

纳入了55 名患者，平均年龄 65.8 (± 13.1) 岁，NIHSS 评分中位数为 15.5 ^{5–24 。}Light 在 6 名评价者中对有利与不利 CAPS 的 kappa 为 0.633（95% CI 0.497–0.785）。CLEOS 增加与不良结果的几率升高相关（比值比 (OR) 1.0010，95% CI 1.0007–1.0014，p<0.01），但 CAPS 则不然（OR 1.0028，95% CI 0.9420–1.0676，p=0.93） . CLEOS (AUC 0.69, 95% CI 0.54–0.84) 与 CAPS (AUC 0.49, 95% CI 0.34–0.64; p=0.051) 观察到总体有利趋势。在 85.5% 的血管内再灌注患者中，CLEOS 在识别不良 90 天结果方面的敏感性在统计学上高于 CAPS（71% 对 21%，p=0.003）。

结论

CLEOS 表现出比 CAPS 更好的预测能力，可预测总体不良结果和基底血栓切除术后实现再灌注的患者。