Posterior Circulation Infarction Research Articles

Recurrent Posterior Circulation Infarction Caused by Vertebral Artery Dissection Secondary to Atlas Hypoplasia.

Recurrent Posterior Circulation Infarction Caused by Vertebral Artery Dissection Secondary to Atlas Hypoplasia.

ASTRAL scale for predicting prognosis following intravenous thrombolysis with anterior versus posterior circulation acute ischemic stroke.

In this study, we compared whether there was any difference between the ASTRAL(Acute Stroke Registry and Analysis of Lausanne, ASTRAL) scale in predicting prognosis after IVT(Intravenous Thrombolysis, IVT) in patients with AIS(Acute Ischemic Stroke, AIS) in the ACI(Anterior Circulation Infarction, ACI) and PCI(Posterior Circulation Infarction, PCI), with the aim of providing more guiding information. Statistical analysis was performed using SPSS 25.0. When comparing the baseline characteristics, the normal distribution test was carried out first, which did not conform to the normal distribution. The continuous variables were expressed in the median and interquartile, and the nonparametric double-independent sample test was carried out. MedCalc software was used to plot ROC(Receiver Operating Characteristic, ROC) curves, calculate AUC(Area Under the Receiver Operating Characteristic Curve, AUC), and compare the prediction performance of the ASTRAL score by Delong text, and the difference of P < 0.05 was statistically significant. The AUCs of ASTRAL in predicting poor prognosis of ACI and PCI patients after IVT were 0.768 and 0.773, respectively. There was no difference in the AUC of ASTRAL score between ACI and PCI(P > 0.05). The ASTRAL scale has consistent prognostic predictive value for AIS in the anterior and posterior circulatory systems and is a reliable tool for predicting poor prognosis of patients with ACI and PCI after IVT.

Basilar Artery Tortuosity Increases the Risk of Persistent Dizziness and Unsteadiness After Posterior Circulation Infarction.

Basilar artery (BA) tortuosity is closely associated with posterior circulation infarction (PCI) and dizziness/unsteadiness. This study aims to determine the relationship between BA tortuosity and the outcome of dizziness and unsteadiness in PCI patients. This study prospectively recruited PCI patients presenting with dizziness and unsteadiness. BA tortuosity was diagnosed based on Smoker's criteria. The BA tortuosity index (BATI) was measured from magnetic resonance angiography (MRA) images. Posterior circulation was divided into proximal (medulla oblongata and posterior inferior cerebellar), middle, and distal territories. Symptoms, risk of falls, and quality of life were followed up in 3 months after stroke. Logistic regression was used to identify possible factors associated with the persistence of dizziness and unsteadiness. Among 182 PCI patients presenting with dizziness and unsteadiness, 97 (53.3%) had BA tortuosity, including 19 (10.4%) with moderate-to-severe BA tortuosity. At the 3-month follow-up, 58 (31.9%) patients continued to experience dizziness and unsteadiness, with significantly decreased quality of life and a high risk of falls. Binary logistic regression analysis identified moderate-to-severe BA tortuosity (OR, 4.474; 95% CI, 1.591-12.579; p = 0.004) and lesions involving the proximal posterior circulation territory (OR, 2.146; 95% CI, 1.097-4.199; p = 0.026) as risk factors for persistent dizziness and unsteadiness after PCI, while thrombolysis (OR, 0.280; 95% CI, 0.079-0.992; p = 0.049) as a protective factor. BATI (OR, 1.072; 95% CI, 1.028-1.119; p = 0.001) was also independently associated with dizziness and unsteadiness after PCI. Prominent BA tortuosity increases the risk of persistent dizziness and unsteadiness after PCI, leading to a high risk of falls and decreased quality of life. This warrants more attention in clinical practice.

Deep Learning Classification of Ischemic Stroke Territory on Diffusion-Weighted MRI: Added Value of Augmenting the Input with Image Transformations.

Our primary aim with this study was to build a patient-level classifier for stroke territory in DWI using AI to facilitate fast triage of stroke to a dedicated stroke center. A retrospective collection of DWI images of 271 and 122 consecutive acute ischemic stroke patients from two centers was carried out. Pretrained MobileNetV2 and EfficientNetB0 architectures were used to classify territorial subtypes as middle cerebral artery, posterior circulation, or watershed infarcts along with normal slices. Various input combinations using edge maps, thresholding, and hard attention versions were explored. The effect of augmenting the three-channel inputs of pre-trained models on classification performance was analyzed. ROC analyses and confusion matrix-derived performance metrics of the models were reported. Of the 271 patients included in this study, 151 (55.7%) were male and 120 (44.3%) were female. One hundred twenty-nine patients had MCA (47.6%), 65 patients had posterior circulation (24%), and 77 patients had watershed (28.0%) infarcts for center 1. Of the 122 patients from center 2, 78 (64%) were male and 44 (34%) were female. Fifty-two patients (43%) had MCA, 51 patients had posterior circulation (42%), and 19 (15%) patients had watershed infarcts. The Mobile-Crop model had the best performance with 0.95 accuracy and a 0.91 mean f1 score for slice-wise classification and 0.88 accuracy on external test sets, along with a 0.92 mean AUC. In conclusion, modified pre-trained models may be augmented with the transformation of images to provide a more accurate classification of affected territory by stroke in DWI.

Perfusion imaging predicts short-term clinical outcome in isolated posterior cerebral artery occlusion stroke.

Ischemic strokes due to isolated posterior cerebral artery (PCA) occlusions represent 5% of all strokes but have significant impacts on patients' quality of life, primarily due to visual deficits and thalamic involvement. Current guidelines for acute PCA occlusion management are sparse, and the prognostic value of perfusion imaging parameters remains underexplored. We conducted a retrospective analysis of 32 patients with isolated PCA occlusions treated at Johns Hopkins Medical Institutions between January 2017 and March 2023. Patients underwent pretreatment perfusion imaging, with perfusion parameters analyzed using RAPID software. The primary outcome was short-term clinical outcome as measured by the National Institutes of Health Stroke Scale (NIHSS) at discharge. The median age of the cohort was 70years, with 34% female and 66% male. Significant correlations were found between NIHSS at discharge and various perfusion parameters, including time-to-maximum (Tmax) >6seconds (ρ=.55, p=.004), Tmax >8seconds (ρ=.59, p=.002), Tmax >10seconds (ρ=.6, p=.001), mismatch volume (ρ=.51, p=.008), and cerebral blood volume (CBV) < 34% (ρ=.59, p=.002). Tmax and CBV volumes significantly correlated with discharge NIHSS with marginal superiority of Tmax >10seconds and CBV <42% volumes. These findings suggest that CT and MR perfusion imaging can play a crucial role in the acute management of PCA strokes, though larger, standardized studies are needed to validate these results and refine imaging thresholds specific to posterior circulation infarcts.

Vertebral artery pseudoaneurysm: a rare cause of posterior circulation infarction in a middle-aged man.

Pseudoaneurysm of the vertebral artery is a rare cause of posterior circulation stroke. Treatment for this condition can be achieved through microscopic surgery or endovascular therapy. We report a case of a 36-year-old middle-aged male patient who presented with left limb numbness as the sole complaint. On a magnetic resonance imaging examination, multiple infarcts were observed in the left cerebellar tonsil. A subsequent head and neck computed tomography angiography examination led to the diagnosis of a pseudoaneurysm in the left vertebral artery. Following standard antiplatelet therapy, the patient underwent endovascular intervention. The patient's left limb numbness gradually subsided after surgery. A follow-up angiography performed 1 week after discharge showed no recurrence. These findings suggest that covered stent placement is an effective method of treating pseudoaneurysm of the vertebral artery.

Association between Bilateral Vertebral Artery Blood Flow Changes and Posterior Circulation Infarction in Patients with Severe Intracranial Stenosis

Plain Language SummaryThis study investigates the relationship between vertebral artery (VA) blood flow and posterior circulation infarctions (PCI), which are strokes in the back of the brain. VAs play a crucial role in supplying blood to this area. Using color duplex ultrasonography, we measured blood flow in 234 patients with severe VA narrowing (≥70%). These patients were divided into two groups: those who had experienced PCI and those who had not. We analyzed the correlation between blood flow in the VAs and various brain imaging data to understand the occurrence of PCI under different conditions. The findings showed that lower blood flow through the VAs was significantly associated with a higher risk of PCI, particularly in cases involving large artery atherosclerosis (a type of artery disease). However, this association was not observed in cases of branch artery occlusive disease. A detailed analysis revealed that for every 10 mL/min increase in blood flow, the risk of PCI decreased by 11%. This relationship also varied according to the patients’ blood glucose levels: patients with lower blood glucose levels showed a stronger link between increased blood flow and reduced PCI risk compared to those with moderate or high blood glucose levels. In conclusion, measuring the blood flow in the VAs can help identify patients at high risk of strokes in the back part of the brain. However, it is important to consider this measurement in combination with blood glucose levels to improve the identification of high-risk patients.

Erratum. Predictors of unexplained early neurological deterioration after thrombectomy for posterior circulation infarction: a reanalysis of the BASILAR study.

Erratum. Predictors of unexplained early neurological deterioration after thrombectomy for posterior circulation infarction: a reanalysis of the BASILAR study.

Posterior Circulation Ischemic Stroke Is Associated with More Severe Forward Head Posture in Patients with Cervicalgia

Chronic risk factors of posterior circulation ischemic strokes remain unknown. There is, however, evidence that anatomical variations within the vertebrobasilar system could potentially lead to the development of posterior circulation strokes. We investigated the association of forward head posturing (FHP), a chronic anatomical change seen in patients with cervicalgia, with posterior circulation strokes. In this case-control study, we identified adult patients diagnosed with cervicalgia and ischemic posterior circulation infarcts from 2007 to 2023. Cases were paired with controls with cervicalgia without posterior circulation stroke and matched for known risk factors. C0-C2 angle, C2-C7 angle, and sagittal vertical axis shift were measured as metrics for FHP severity on lateral cervical spine x-rays. Paired t tests were applied to compare stroke risk factors and FHP between groups. Participants included 206 patients (103 cases and 103 controls) with a mean age of 64.4 years; 51.5% were female. There were no statistically significant differences between risk factors for stroke, including hypertension, hyperlipidemia, diabetes, smoking, hypercoagulable state, and atrial fibrillation. There were statistically significant differences in C0-C2 angle (30.7° vs. 23.2°, P=0.002) and sagittal vertical axis shift (35.4 mm vs. 25.3 mm, P < 0.001). This case-control matched-pair study found that in adults with cervicalgia, posterior circulation ischemic stroke was associated with more severe FHP as noted in C0-C2 angle and sagittal vertical axis shift measurements. Further, this association may be due to chronic changes in circulation flow dynamics within the vertebrobasilar system with the postural change.

Which is a more appropriate recipient for posterior circulation bypass surgery: V3 or V2? Differences in underlying disease and lesion sites between extracranial vertebral artery dissection and atherosclerotic changes. Illustrative cases.

Revascularization for extracranial vertebral artery dissection or vertebral artery atherosclerotic occlusive lesions caused by vertebrobasilar insufficiency or posterior circulation infarction is relatively rare. When bypassing the cervical external carotid artery (ECA) or common carotid artery (CCA) using a radial artery (RA) or saphenous vein (SV) graft, it is difficult to determine whether the recipient site should be the V2 or V3 portion. In case 1, cervical ECA-RA-V3 bypass was performed for bilateral extracranial vertebral artery dissection with the onset of ischemia, and cervical CCA-SV-V3 bypass was added 12 days later. Nine years after surgery, the bilateral vertebral artery dissection had improved, and the patient still had a patent bypass. In case 2, cervical ECA-RA-V2 bypass was performed for arteriosclerotic bilateral extracranial vertebral artery occlusion. The bypass was patent 5 years after surgery. The postoperative course was uneventful in both patients. The authors present cases of posterior fossa revascularization using the vertebral artery V3 and V2 portions via skull base surgery and note that it is important to consider each patient's individual characteristics when selecting the V3 or V2 portion.

Relationship Between Subclavian Artery Stenosis Lesions and Posterior Circulation Infarction: A Preliminary Study

To investigate the correlation between subclavian steal syndrome and posterior circulation infarction using magnetic resonance imaging. A total of 294 patients diagnosed with subclavian steal syndrome using carotid Doppler ultrasonography were retrospectively included. According to the magnetic resonance imaging results, they were divided into posterior circulation infarction group and nonposterior circulation infarction group. Clinical indicators and carotid Doppler ultrasound parameters of patients were collected, and they were screened to establish a multiple logistic regression model. Receiver operating characteristic curve analysis of the established multiple logistic regression model was performed, and the area under the curve was calculated to evaluate the predictive efficiency of the model. After statistical analysis of all parameters of the 2 groups of patients, a total of 10 parameters were included in multiple logistic regression to establish a model. The results showed a correlation between posterior circulation infarction and subclavian artery occlusion, grade III subclavian steal syndrome, gender, vulnerable plaques, National Institutes of Health Stroke Scale score, and age. After the receiver operating characteristic curve analysis of the model, the area under the curve for the multiple logistic regression model was 0.773. The multiparameter composite model based on clinical baseline data and carotid Doppler ultrasonography parameters can effectively predict posterior circulation infarction and offer novel insight for clinical diagnosis.

Rare case of massive middle cerebral artery infarct after bronchial artery embolisation

Bronchial artery embolization (BAE) is a procedure that aims to control bleeding from bronchial arteries in massive and chronic haemoptysis. It is considered to be a life-saving measure in severe life-threating haemoptysis. Although it is minimally invasive and has a high success rate, it still carries a list of complications. These include post-embolisation syndrome, chest pain, back pain, dysphagia, vascular injury at the site of the embolisation leading to dissection, perforation, pseudoaneurysm and, very rarely, embolic infarction to non-target vessels. Stroke is one of the rare complications post BAE, and it can be severe and fatal. Few cases of stroke post BAE have been reported in the literature, and they were mainly due to posterior cerebral circulation infarction. Here, we report a case of a stroke post BAE due to massive middle cerebral artery (MCA) infarction and to our knowledge it seems to be the first reported case of MCA infarction post BAE. The discussion will cover the possible mechanisms of embolic passage, the outcome of the case including rehabilitation perspectives and the learning points. These will also highlight the importance of early recognition, which can save patients from a disabling stroke in the future.

Investigation of the Relationship Between Cervical Vertebral Column Degeneration and Posterior Circulation Perfusion Area Ischemia

Aim: The primary objective of this study was to establish whether degeneration of the cervical vertebrae and paravertebral structures serves as a predisposing factor for ischemic processes by disrupting hemodynamics in the posterior system through mechanical effects on the vertebral arteries. Material and Method: We conducted a retrospective analysis of 180 patients who underwent various imaging tests between January 2017 and October 2023. These tests included cervical magnetic resonance imaging (MRI), cervical computed tomography (CT), carotid-vertebral neck CT angiography (CTA), cranial CT, and cranial MRI. Of the 180 patients, 90 had mild degeneration or no significant degeneration, with a mean age of 58 years, and 90 had significant cervical spondylosis (CS) with a mean age of 64 years. The radiological findings were statistically analyzed, and a p-value of less than 0.05 was considered statistically significant. Results: There was no significant difference between age and parenchymal density in the control group (p=0.09). There was no statistically significant difference between the age and parenchymal density in the CS group (p=0.07). As CS became more severe, there was a statistically significant increase in the incidence of atrophic enlargement of the cerebellar folia and loss of density in the posterior fossa (p=0.03) and posterior circulation infarcts (POCI) (p=0.04). Conclusion: When severe, CS can adversely affect vascular hemodynamics in the posterior system, predisposing perfused neural parenchyma to ischemia.

Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) Mimicking Posterior Circulation Infarction

CLIPPERS is a rare inflammatory condition of the central nervous system. It is pathologically characterised by white matter perivascular lymphohistiocytic infiltrate with or without parenchymal extension. A male patient in mid sixties presented with dysarthria and facial numbness underwent an MRI brain which supported a diagnosis of a subacute posterior circulation infarct. The patient re-presented with worsening of symptoms and a repeat MRI revealed changes atypical for ischaemia and consistent with CLIPPERS. Our case represents a common presentation of a very rare condition.

Application of 3D-PCASL combined with t-ASL and MRA in the diagnosis of patients with isolated vertigo induced by posterior circulation ischemia

ObjectivesIsolated vertigo induced by posterior circulation ischemia (PCIV) can further progress into posterior circulation infarction. This study aimed to explore the diagnostic values of three-dimensional pseudo-continuous arterial spin labeling (3D-PCASL) combined with territorial arterial spin labeling (t-ASL) and magnetic resonance angiography (MRA) in visualizing and evaluating PCIV, seeking improved diagnostic tools for clinical guidance. Methods28 PCIVs (11 males, 17 females, aged from 55 to 83 years, mean age: 69.68 ± 9.01 years) and 28 healthy controls (HCs, 12 male, 16 female, aged from 56 to 87 years, mean age: 66.75 ± 9.86 years) underwent conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), MRA, 3D-PCASL, and t-ASL. We compared the incidence of anatomic variants of the posterior circle of Willis in MRA, cerebral blood flow (CBF) and anterior collateral blood flow on postprocessing maps obtained from 3D-PCASL and t-ASL sequence between PCIVs and HCs. Chi-square test and paired t-test were analyzed statistically with SPSS 24.0 software. Results7 PCIVs (7/28, 25%) and 6 HCs (6/28, 21%) showed fetal posterior cerebral artery (FPCA) on MRA, including 1 HC, and 6 PCIVs with FPCA appeared hypoperfusion. 18 PCIVs (64%) and 2 HCs (7%) showed hypoperfusion in the posterior circulation (PC), including 1 HC and 7 PCIVs displayed anterior circulation collateral flow. Chi-square analyses demonstrated a difference in PC hypoperfusion between PCIVs and HCs, whether in the whole or FPCA-positive group assessment (P < 0.05). Paired t-test showed that the CBF values were significant difference for the bilateral PC asymmetrical perfusion in the PCIVs (P < 0.01). When compared to the bilateral PC symmetrical non-hypoperfusion area in the PCIVs and HCs, the CBF values were not significant (P > 0.05). The CBF values of the PC in PCIVs were lower than in HCs (P < 0.05). The reduction rate in the hypoperfusion side of the bilateral PC asymmetrical perfusion of the PCIVs ranged from 4% to 37%, while the HCs reduction rate was 7.7%. The average PC symmetrical perfusion average reduction rate of the PCIVs was 52.25%, while the HCs reduction rate was 42.75%. Conclusion3D-PCASL is a non-invasive and susceptible method for detecting hypoperfusion in PC, serving as a potential biomarker of PCIV. The suspected hypoperfusion in PC may be attributed to the emergence of FPCA and the manifestation of anterior collateral flow when combining t-ASL and MRA sequences. These findings demonstrated that 3D-PCASL combined with t-ASL and MRA sequences are the potential method to identify PCIV, leading to early diagnosis of PCIV and reducing the risk of progressing into infarction.

Inflammatory Type Focal Cerebral Arteriopathy of the Posterior Circulation in Children: A Comparative Cohort Study.

Inflammatory type focal cerebral arteriopathy (FCA-i) in the anterior circulation (AC) is well characterized, and the focal cerebral arteriopathy severity score (FCASS) reflects the severity of the disease. We identified cases of FCA-i in the posterior circulation (PC) and adapted the FCASS to describe these cases. In this comparative cohort study, patients from the Swiss NeuroPaediatric Stroke Registry with ischemic stroke due to FCA-i between January 2000 and December 2018 were analyzed. A comparison between PC and AC cases regarding pediatric National Institutes of Health Stroke Scale score and pediatric stroke outcome measure and FCASS was performed. We estimated infarct size by the modified pediatric Alberta Stroke Program Early Computed Tomography Score in children with AC stroke and the adapted Bernese posterior diffusion-weighted imaging score in the PC. Thirty-five children with a median age of 6.3 (interquartile range, 2.7-8.2 [95% CI, 0.9-15.6]; 20 male; 57.1%) years with FCA-i were identified. The total incidence rate was 0.15/100 000/year (95% CI, 0.11-0.21). Six had PC-FCA-i. Time to final FCASS was longer in the PC compared with AC; the evolution of FCASS did not differ. Initial pediatric National Institutes of Health Stroke Scale score was higher in children with FCA-i in the PC with a median of 10.0 (interquartile range, 5.75-21.0) compared with 4.5 (interquartile range, 2.0-8.0) in those with AC-FCA-i. Different from the anterior cases, PC infarct volume did not correlate with higher discharge, maximum, or final FCASS scores (Pearson correlation coefficient [r], 0.25, 0.35, and 0.54). FCA-i also affects the PC. These cases should be included in future investigations into FCA-i. Although it did not correlate with clinical outcomes in our cohort, the modified FCASS may well serve as a marker for the evolution of the arteriopathy in posterior FCA-i.

Predictors of atrial fibrillation detection in embolic stroke of undetermined source patients with implantable loop recorder.

Covert atrial fibrillation (AF) is a predominant aetiology of embolic stroke of undetermined source (ESUS). Evidence suggested that AF is more frequently detected by implantable loop recorder (ILR) than by conventional monitoring. However, the predictive factors associated with occult AF detected using ILRs are not well established yet. In this study we aim to investigate the predictors of AF detection in patients with ESUS undergoing an ILR. This observational multi-centre study included consecutive ESUS patients who underwent ILR implantation. The infarcts were divided in deep, cortical infarcts or both. The infarction sites were categorized as anterior and middle cerebral artery, posterior cerebral artery with and without brainstem/cerebellum involvement. Multivariable logistic regression analysis was performed to investigate variables associated with AF detection. Overall, 3,000 patients were initially identified. However, in total, 127 patients who consecutively underwent ILR implantation were included in our analysis. AF was detected in 33 (26%) out of 127 patients. The median follow-up was 411 days. There were no significant differences in clinical characteristics and comorbidities between patients with and without AF detected. AF was detected more often after posterior cerebral artery infarct with brainstem/cerebellum involvement (p < 0.001) whereas less often after infarction in the anterior and middle cerebral artery (p = 0.021). Multivariable regression analysis demonstrated that posterior cerebral artery infarct with brainstem/cerebellum involvement was an independent predictor of AF detection. Our study showed that posterior circulation infarcts with brainstem/cerebellum involvement are associated with AF detection in ESUS patients undergoing ILR. Larger prospective studies are needed to validate our findings.

Acute concurrent bilateral internal carotid artery occlusion: a teaching clinical image

Acute bilateral internal carotid artery (ICA) occlusion is a rare stroke syndrome presenting with acute coma, and patients usually have preserved brainstem function on initial examination. In this clinical image, we report a case of acute concurrent bilateral ICA occlusion. Acute bilateral ICA occlusion is an unusual entity with a poor outcome. It can mimic metabolic encephalopathies and posterior circulation infarcts and can be differentiated by careful evaluation of brainstem functions.

Long term for patients with futile endovascular reperfusion after stroke.

With the progress of thrombectomy technology, the vascular recanalization rate of patients with stroke has been continuously improved, but the proportion of futile recanalization (FR) is still quite a few. The long-term prognosis and survival of patients with FR and its influencing factors remain unclear. Consecutive patients who received endovascular treatment (EVT) for ischemic stroke were enrolled between 2013 and 2021 from a single-center prospectively registry study. We evaluated the long-term outcome of these patients by Kaplan-Meier survival analysis, and the multivariable logistic regression curve was performed to analyze influencing factors. Among 458 patients with FR, 56.4% of patients survived at 1 year, and 50.4% at 2 years. In the multivariate regression analysis, age, premorbid modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), posterior circulation infarct, general anesthesia, symptomatic intracerebral hemorrhage (sICH), and decompressive craniectomy were found to be related to unfavorable outcomes in long-term. Age, premorbid mRS, NIHSS, general anesthesia, and sICH were predictors of long-term mortality. Futile recanalization accounts for a large proportion of stroke patients after thrombectomy. This study on the long-term prognosis of such patients is beneficial to the formulation of treatment plans and the prediction of therapeutic effects.

Development and validation of a novel scoring system for acute ischemic stroke

BackgroundThis study aimed to assess the clinical application of the Artery Occlusion Image Score (AOIS), a new metric based on computed tomographic angiography (CTA) that reflects the severity of occlusive changes in the main intracranial arteries.Materials and MethodsPatients diagnosed with acute ischemic stroke (AIS) were divided into three groups: anterior circulation infarcts (ACI group), posterior circulation infarcts (PCI group), and both anterior and posterior circulation infarcts (ACI + PCI group). The sensitivity and specificity of AOIS were evaluated using the Basilar Artery on Computed Tomography Angiography (BATMAN) score, the Clot Burden Score (CBS), and the National Institutes of Health Stroke Scale (NIHSS) as comparators through receiver-operating characteristic (ROC) curve analysis.ResultsThe final analysis included 439 consecutive patients. In the ACI group, AOIS demonstrated high sensitivity (86.3%) and specificity (85.0%) and outperformed CBS in predicting patient prognosis. In the PCI group, AOIS also showed high sensitivity (88.9%) and specificity (90.0%) and outperformed BATMAN in predicting patient prognosis. In the ACI + PCI group, AOIS positively correlated with the NIHSS score (Spearman’s ρ = 0.602, P < .001). Additionally, the scoring time of AOIS did not significantly differ from CBS and BATMAN.ConclusionAOIS is a convenient and reliable method for guiding treatment and predicting outcomes in patients with ACI or/and PCI. Furthermore, AOIS is the first CTA-based scoring system that covers both the anterior and posterior circulation, providing a convenient and reliable evaluation for patients with concurrent acute ischemic stroke in both circulations.