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World Neurosurg. 2019 May 31. pii: S1878-8750(19)31494-9. doi: 10.1016/j.wneu.2019.05.217. [Epub ahead of print]

Posterior Circulation Thrombectomy - pcASPECT Score Applied to Pre-intervention MRI Can Accurately Predict Functional Outcome.

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Department of Neurosurgery, University of California, Los Angeles. Electronic address:
Department of Radiology, University of California, Los Angeles.
Department of Neurology, University of California, Los Angeles.



There are currently no imaging criteria to identify patients who would benefit from endovascular recanalization of posterior circulation strokes. Applying the pc-ASPECTS to MRI has been demonstrated to be an accurate predictor of functional outcome. Here, we aimed to evaluate the accuracy of pc-ASPECTS with pre-intervention MRI as a predictor of functional outcome in a cohort undergoing endovascular recanalization.


This is a fifteen-year retrospective study of patients undergoing endovascular recanalization of posterior circulation with baseline MRI or CT. We analyzed baseline imaging, clinical data, type and timing of intervention to the functional outcome at 90-days. Using MRI pc-ASPECTS, we evaluated inter-rater reliability, accuracy in predicting functional outcome, and compared it to the use of single anatomic location for this function.


Door-to-recanalization time in the MRI cohort was significantly longer (median: 8.7 vs. 2.7-hours, p=0.03); however, functional outcome was not different. Within the MRI cohort, pc-ASPECTS and NIHSS were the only factors that were significantly different between the groups with good and bad functional outcome (p<0.001). The area under the receiver operating characteristic curve for pc-ASPECTS and good functional outcome was 0.96, with the optimal threshold of 8 or above resulting in positive predictive value of 90% and negative predictive value of 100%.


Despite longer time-to-intervention with MRI as the initial imaging modality in posterior circulation strokes, it does not negatively affect the functional outcome. Pc-ASPECTS is an easy to use and accurate prognostic tool for the real-time evaluation of pre-intervention MRI in this population.


MRI; acute stroke therapy; intervention; ischemic stroke; posterior circulation; prognosis


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