ASFNR Issues Imaging Framework for Posterior Circulation Large Vessel Occlusion Stroke

ASFNR clinical state-of-practice: For posterior circulation large vessel occlusion stroke, use noncontrast CT to exclude hemorrhage, CT angiography to identify occlusion, and MRI with DWI as reference standard. Imaging scores like PC-ASPECTS help select patients for thrombectomy.

• NCCT is insensitive for ischemia but essential for excluding hemorrhage; CTA is the diagnostic cornerstone for identifying posterior circulation large vessel occlusion.
• CT perfusion has limited sensitivity in the posterior fossa, while DWI-MRI remains the reference standard despite early false negatives and unreliable DWI-FLAIR mismatch.
• Imaging biomarkers including PC-ASPECTS and brainstem infarct scores are crucial for patient selection and outcome prediction in basilar artery occlusion.

Automated summary

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