Posterior circulation acute stroke prognosis early CT scores in predicting functional outcomes: A meta-analysis.

Wei-Zhen Lu,Hui-An Lin,Sheng-Feng Lin,Chyi-Huey Bai,Miguel A Barboza

doi:10.1371/journal.pone.0246906

Abstract

Patients with posterior circulation acute ischemic stroke exhibit varied clinical presentations and functional outcomes. Whether posterior circulation acute stroke prognosis early computed tomography scores (PC-ASPECTS) predict unfavorable functional outcomes (UFO) for patients treated with different therapeutic regimens is unclear. According to PRISMA guidelines, we performed a systematic search of electronic databases for studies assessing the functional outcomes of posterior circulation acute ischemic stroke using baseline PC-ASPECTS. The following three scales of PC-ASPECTS were retrieved: UFO prediction by using PC-ASPECTS per score decrease, UFO prediction by using binary PC-ASPECTS with a cut-off value, and the difference in PC-ASPECTS between patients with unfavorable and favorable functional outcomes. Moreover, a subgroup analysis was conducted for patients treated with intra-arterial endovascular treatment (IA-EVT) only. Sensitivity analysis with different definition of UFO and image modalities were also conducted. In total, 25 studies were included. In scale 1, PC-ASPECTS significantly predicted UFO (odds ratio [OR]: 1.66 per score decrease, 95% confidence interval [CI]: 1.32-2.07). In scale 2, binary PC-ASPECTS with a cut-off value between 6 and 9 significantly predicted UFO (OR: 3.91, 95% CI: 2.54-6.01). In scale 3, patients with UFO had lower PC-ASPECTS than those with favorable outcomes (standardized mean difference [SMD]: -0.67, 95% CI: -0.8 to -0.55). For patients treated with IA-EVT only, the scales demonstrated consistent results. Sensitivity analysis showed PC-ASPECTS significantly predicted UFO in both definitions of modified Rankin Scale ≥ 3 and ≥ 4, and magnetic resonance imaging was preferred imaging modality for PC-ASPECTS evaluation. Baseline PC-ASPECTS is effective in predicting UFO for patients with posterior circulation acute ischemic stroke treated with different therapeutic regimens.

Highlights

Posterior circulation infarction accounts for one-fifth to one-fourth of all incidents of acute ischemic stroke [1,2] and has varied clinical presentations [3,4,5]
In scale 2, binary PC-ASPECTS with a cut-off value between 6 and 9 significantly predicted unfavorable functional outcomes (UFO) (OR: 3.91, 95% confidence interval (CI): 2.54–6.01)
In scale 3, patients with UFO had lower PC-ASPECTS than those with favorable outcomes

Summary

Introduction

Posterior circulation infarction accounts for one-fifth to one-fourth of all incidents of acute ischemic stroke [1,2] and has varied clinical presentations [3,4,5]. Similar to ASPECTS, posterior circulation Alberta stroke program early CT scores (PC-ASPECTS) allots 10 points to assess early ischemic changes on computed tomography angiography-source imaging (CTA-SI) or diffusion-weighted imaging (DWI) of magnetic resonance imaging (MRI) [12]. These 10 points provide semiquantitative estimates of the region of posterior circulation infarction, which include each side of the cerebellum (1 point), occipital lobe (1 point), thalamus (1 point), pons (2 point), and midbrain (2 point). Whether posterior circulation acute stroke prognosis early computed tomography scores (PC-ASPECTS) predict unfavorable functional outcomes (UFO) for patients treated with different therapeutic regimens is unclear

Methods

Results

Conclusion