The Charlotte Large Artery Occlusion Endovascular Therapy Outcome Score Compares Favorably to the Critical Area Perfusion Score for Prognostication Before Basilar Thrombectomy. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association Karamchandani, R. R., Satyanarayana, S., Yang, H., Rhoten, J. B., Strong, D., Singh, S., Clemente, J. D., Defilipp, G., Hazim, M., Patel, N. M., Bernard, J., Stetler, W. R., Parish, J. M., Blackwell, T. A., Heit, J. J., Albers, G. W., Saba, K., Guzik, A. K., Wolfe, S. Q., Asimos, A. W. 2023; 32 (7): 107147


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).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.55 patients, mean age 65.8 (± 13.1) years and median NIHSS score 15.55-24, 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).CLEOS demonstrated better predictive ability than CAPS for poor outcomes overall and in patients achieving reperfusion after basilar thrombectomy.

View details for DOI 10.1016/j.jstrokecerebrovasdis.2023.107147

View details for PubMedID 37119791