{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T14:10:37Z","timestamp":1785334237379,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T00:00:00Z","timestamp":1658966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Purpose: Acute basilar artery occlusion, a neurovascular emergency leading to high rates of morbidity and mortality, is usually diagnosed by CT imaging. The outcome is partly dependent on etiology, with a worse outcome in occlusions with underlying basilar artery stenosis. As this occlusion type requires a more complex angiographic therapy, this study aimed to develop new CT markers in emergency admission imaging to rapidly identify underlying stenosis. Methods: A total of 213 consecutive patients (female n = 91, age in years (mean\/SD\/range): 72\/13\/28\u201397), who received endovascular treatment at a single comprehensive stroke center for acute basilar artery occlusion, were included in this study. After applying strict inclusion criteria for imaging analyses, novel CT imaging markers, such as \u2018absolute density loss\u2019 (ADL) and relative thrombus attenuation (CTA-index), that measure perviousness, were assessed for n = 109 patients by use of CT-angiography and correlated to different occlusion patterns (thrombotic vs. embolic). Inter-observer agreement was assessed using an intraclass correlation coefficient for independent measures of a radiologist and a neuroradiologist. Associations between the imaging markers and clinical and interventional parameters were tested. Results: CT markers differ between the subgroups of basilar artery occlusions with and without underlying stenosis (for ADL: 169 vs. 227 HU (p = 0.03), for CTA-index: 0.55 vs. 0.70 (p &lt; 0.001)), indicating a higher perviousness in the case of stenosis. A good inter-rater agreement was observed for ADL and CTA-index measures (ICC 0.92\/0.88). For the case of embolic occlusions, a more pervious thrombus correlates to shorter time intervals, longer procedure times, and worse reperfusion success (p-values &lt; 0.05, respectively). Conclusions: ADL and CTA-index are easy to assess in the emergency setting of acute basilar artery occlusion with the use of routinely acquired CT-angiography. They show a high potential to differentiate thrombotic from embolic occlusions, with an impact on therapeutic decisions and angiographic procedures. Measurements can be quickly performed with good reliability, facilitating implementation in clinical practice.<\/jats:p>","DOI":"10.3390\/diagnostics12081817","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T20:49:28Z","timestamp":1659041368000},"page":"1817","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["CT Marker in Emergency Imaging of Acute Basilar Artery Occlusion: Thrombosis vs. Embolism"],"prefix":"10.3390","volume":"12","author":[{"given":"Fabian","family":"Mueck","sequence":"first","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, HELIOS Clinics Munich West, Munich Perlach & Augustinum Munich, 81241 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-3863","authenticated-orcid":false,"given":"Moritz","family":"Hernandez Petzsche","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0266-8947","authenticated-orcid":false,"given":"Tobias","family":"Boeckh-Behrens","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4885-7671","authenticated-orcid":false,"given":"Christian","family":"Maegerlein","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Linsenmaier","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology, HELIOS Clinics Munich West, Munich Perlach & Augustinum Munich, 81241 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0910-8064","authenticated-orcid":false,"given":"Mariano","family":"Scaglione","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Sassari, 07100 Sassari SS, IT and James Cook University Hospital, Middlesbrough TS4 3BW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benno","family":"Ikenberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Berndt","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1161\/01.STR.0000247897.33267.42","article-title":"Intra-arterial thrombolytic therapy for acute basilar occlusion: Pro","volume":"38","author":"Smith","year":"2007","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/S1474-4422(11)70229-0","article-title":"Basilar artery occlusion","volume":"10","author":"Mattle","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.03.033","article-title":"Etiology and Risk Factors of Posterior Circulation Infarction Compared with Anterior Circulation Infarction","volume":"24","author":"Zeng","year":"2015","journal-title":"J. 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