Clinical trial NCT06094569: Medical Imaging Screening for Posterior-circulation Ischemic Stroke
Official title: Medical Imaging Screening for Posterior-circulation Ischemic Stroke：a Multicentre,Imaging-based,Prospective Cohort Study
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Endovascular Thrombectomy
Keywords: select patients
endovascular thrombectomy
magnetic resonance imaging
diffusion weighted imaging
Vertebrobasilar artery
Lead sponsor: Tianjin Huanhu Hospital
Sponsor class: OTHER
First posted: 2023-10-23
Enrollment: 1000
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All acute ischemic strvoke patients with vertebrobasilar artery occlusion.

Brief summary: Patients with ischemic stroke in the posterior circulation continue to have high rates of mortality and disability, even with aggressive treatment. We wanted to evaluate preoperative imaging to screen patients with a good prognosis from mechanical embolization. We assess the degree of ischemia by defining the pons-midbrain-medulla index (PMMI) and correlate the preoperative PMMI with the clinical prognosis of postoperative patients to verify the validity of PMMI in predicting the clinical prognosis of patients with embolization.

Detailed description: * The ENDOSTROKE registry (Endovascular Stroke T reatment Registry), the use of MRI before EVT was associated with significantly better clinical outcomes as compared to CT.
* The purpose of the study will sift patients with posterior circulation ischemia stroke who will get better outcome by Mechanical Thrombectomy by neuroimaging.Specifically, the following assumption will be evaluated: the modified pons-midbrain index in magnetic resonance imaging can predict the clinical outcome of patients with basilar artery thrombosis 90 days after surgery, and can guide whether patients will undergo mechanical thrombectomy later.
* Pons-midbrain-medulla index (PMMI) : We divide pons-midbrain-medulla into the left and right sides by the median line of the brainstem,so we will evaluate ischemia of these six layers which are endowed different score according to the degree of ischemia. Instead of the previous pons-midbrain index (PMI), we select the image layer that shows the largest infarct size among the six parts.Then,we add up six scores that is patient's PMMI. Scoring criteria: At the layer of displaying the maximum infarct size, 2 points are scored if the infarct size exceeds 50% of the total area, 1 point is scored if the infarct size is less than 50% of the total area, and 0 points are scored if there is no infarct.Finally, PMMI values range from 0 to 12 points.
* The investigators conduct a multicenter, prospective cohort study.Preoperative images of patients are evaluated by different groups of imaging physicians to describe the association between preoperative PMMI and clinical prognosis in patients with posterior circulation stroke and to verify its validity.

Eligibility criteria: Inclusion Criteria:

1. Patient admitted from Jun. 1st 2019 to Jan. 1st 2029;
2. Patients with acute ischemic stroke recently；
3. Symptoms persisted at admission, and MRI (including DWI) confirmed acute ischemic vertebrobasilar artery occlusion in the posterior circulation:（single right or left intracranial branch of vertebral artery occlusion ; single basilar occlusion ; both two vertebral arterys and basilar artery）；

Exclusion Criteria:

1.Patiens can not meet the MRI examination conditions(with absolute and relative contraindications).

Primary outcomes:
measure: Modified ranking scale (mRS) at 90 days
timeFrame: 90 days
Secondary outcomes:
measure: Mortality within 90 days
timeFrame: 90 days
Other outcomes:
measure: National Institutes of Health Stroke Scale (NIHSS) scores at 90 days
timeFrame: 90 days
measure: Occurrence of periprocedural complications
timeFrame: 90 days
measure: pc-ASPECT (posterior circulation Alberta Stroke Program Early CT score)
timeFrame: 0 days
Locations:
city: Tianjin
country: China
facility: Tianjin Medical University General Hospital
state: Tianjin
city: Tianjin
country: China
facility: The Sencond Hospital of Tianjin Medical University
state: Tianjin
city: Tianjin
country: China
facility: Tianjin Huanhu Hospital
state: Tianjin
city: Tianjin
country: China
facility: Beijing University Binhai Hospital
state: Tianjin
Study officials:
References: