Abstract
PurposeAppearance of hypointense vessels on susceptibility weighted imaging (SWI) has been reported to correlate with outcome in patients with ischemia of the anterior circulation. This study investigates the correlation between the appearance of hypointense vessels on SWI after recanalization therapy and outcome in patients with basilar artery occlusion.MethodsPatients with basilar artery occlusion who were treated with endovascular recanalization or intravenous alteplase and received an MRI including SWI after therapy were retrieved from the hospital database for retrospective analysis. Posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pcASPECTS) was calculated based on regions displaying hypointense vessels on SWI and compared to lesions on diffusion weighted imaging (DWI). Subsequently, SWI based pcASPECTS was correlated with outcome determined with modified Rankin Scale (mRS), categorized as favorable outcome (mRS 0-2) or unfavorable outcome (3-6).ResultsTwenty-two MRI of patients with basilar artery occlusion were analyzed. In seven out of eight areas of the pcASPECTS hypointense vessels on SWI were significantly correlated to areas of restricted diffusion on DWI. In univariate analysis median pcASPECTS on SWI was significantly higher in patients with favorable outcome (7.5 vs. 5, p=0.02). In a multivariate analysis pcASPECTS on SWI was an independent predictor of favorable outcome (OR 2.02; CI [1.02;3,99]; p=0.04).ConclusionpcASPECTS based on hypointense vessels on SWI after therapy predicts outcome in patients with basilar artery occlusion and might potentially be used as an additional imaging biomarker in the management of patients with stroke in the posterior circulation. This needs to be confirmed in larger prospective clinical trials.
Highlights
Stroke following basilar artery occlusion is a rare disease with high fatality and morbidity [1]
In seven out of eight areas of the pcASPECTS hypointense vessels on susceptibility weighted imaging (SWI) were significantly correlated to areas of restricted diffusion on diffusion weighted imaging (DWI)
PcASPECTS on SWI Predicts Outcome in Basilar Artery Occlusion multivariate analysis pcASPECTS on SWI was an independent predictor of favorable outcome
Summary
Stroke following basilar artery occlusion is a rare disease with high fatality and morbidity [1]. A clear mismatch often cannot be defined, trials have shown that it is possible to make a prognosis based on diffusion weighted imaging (DWI) and computed tomography angiography source images using the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pcASPECTS) [5, 6]. Other parameters such as early recanalization, site of occlusion (proximal, mid-basilar or distal basilar artery) and successful recanalization have been shown to be predictors of outcome [7]. Clinicians need as much information as possible on how to predict outcome in this disease
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