Alemseged Fana, Shah Darshan G, Diomedi Marina, Sallustio Fabrizio, Bivard Andrew, Sharma Gagan, Mitchell Peter J, Dowling Richard J, Bush Steven, Yan Bernard, Caltagirone Carlo, Floris Roberto, Parsons Mark W, Levi Christopher R, Davis Stephen M, Campbell Bruce C V
From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
Stroke. 2017 Mar;48(3):631-637. doi: 10.1161/STROKEAHA.116.015492. Epub 2017 Feb 22.
Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the Basilar Artery on Computed Tomography Angiography (BATMAN) score.
A retrospective analysis of consecutive stroke patients with basilar artery occlusion diagnosed on computed tomographic angiography was performed. BATMAN score is a 10-point computed tomographic angiography-based grading system which incorporates thrombus burden and the presence of collaterals. Reliability was assessed with intraclass coefficient correlation. Good outcome was defined as modified Rankin Scale score of ≤3 at 3 months and successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMAN score was externally validated and compared with the Posterior Circulation Collateral score.
The derivation cohort included 83 patients with 41 in the validation cohort. In receiver operating characteristic (ROC) analysis, BATMAN score had an area under receiver operating characteristic curve of 0.81 (95% confidence interval [CI], 0.7-0.9) in derivation cohort and an area under receiver operating characteristic curve of 0.74 (95% CI, 0.6-0.9) in validation cohort. In logistic regression adjusted for age and clinical severity, BATMAN score of <7 was associated with poor outcome in derivation cohort (odds ratio, 5.5; 95% CI, 1.4-21; =0.01), in validation cohort (odds ratio, 6.9; 95% CI, 1.4-33; =0.01), and in endovascular patients, after adjustment for recanalization and time to treatment (odds ratio, 4.8; 95% CI, 1.2-18; =0.01). BATMAN score of <7 was not associated with recanalization. Interrater agreement was substantial (intraclass coefficient correlation, 0.85; 95% CI, 0.8-0.9). BATMAN score had greater accuracy compared with Posterior Circulation Collateral score (=0.04).
The addition of collateral quality to clot burden in BATMAN score seems to improve prognostic accuracy in basilar artery occlusion patients.
基底动脉闭塞与高致残率和死亡率相关。本研究旨在评估一种新的影像学评分：计算机断层血管造影术基底动脉（BATMAN）评分的预后价值。
对通过计算机断层血管造影术诊断为基底动脉闭塞的连续性卒中患者进行回顾性分析。BATMAN评分是一种基于计算机断层血管造影术的10分分级系统，纳入了血栓负荷和侧支循环情况。通过组内相关系数评估可靠性。良好预后定义为3个月时改良Rankin量表评分为≤3分，成功再灌注定义为脑梗死溶栓2b - 3级。对BATMAN评分进行外部验证，并与后循环侧支循环评分进行比较。
推导队列包括83例患者，验证队列包括41例患者。在受试者工作特征（ROC）分析中，BATMAN评分在推导队列中的受试者工作特征曲线下面积为0.81（95%置信区间[CI]，0.7 - 0.9），在验证队列中的受试者工作特征曲线下面积为0.74（95%CI，0.6 - 0.9）。在对年龄和临床严重程度进行校正的逻辑回归分析中，BATMAN评分<7分与推导队列中不良预后相关（比值比，5.5；95%CI，1.4 - 21；P = 0.01），在验证队列中（比值比，6.9；95%CI，1.4 - 33；P = 0.01），在血管内治疗患者中，在对再通和治疗时间进行校正后（比值比，4.8；95%CI，1.2 - 18；P = 0.01）。BATMAN评分<7分与再通无关。评分者间一致性较高（组内相关系数，0.85；95%CI，0.8 - 0.9）。与后循环侧支循环评分相比，BATMAN评分具有更高的准确性（P = 0.04）。
在BATMAN评分中加入侧支循环质量和血栓负荷似乎可提高基底动脉闭塞患者的预后准确性。
