Recanalization Of Basilar Artery Occlusion Research Articles

Posterior Circulation Ischemia in the Endovascular Era.

To perform literature review of clinical, radiographic, and anatomical features of posterior circulation ischemia (PCI) and systematic review of the literature on the management of basilar artery occlusion (BAO) and associated outcomes. Review of literature was conducted to identify publications describing the risk factors, etiology, clinical presentation, and imaging for PCI. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. PubMed and Ovid MEDLINE were searched from 2009 to 2020 for articles relating to management of BAO. A synthesis was compiled summarizing current evidence on management of BAO. PCI accounts for 15%-20% of strokes. Risk factors are similar to anterior circulation strokes. Dizziness (47%), unilateral limb weakness (41%), and dysarthria (31%) are the most common presenting symptoms. A noncontrast head CT will identify PCI in 21% of cases; diffusion-weighted MRI or CT perfusion increase sensitivity to 85%. Recent trials have shown endovascular therapy can achieve >80% recanalization of BAO. In select patients, 30%-60% who receive endovascular treatment can achieve favorable outcome vs without. A total of 13% achieve good outcome and there is an 86% mortality rate. PCI can present with waxing and waning symptoms or clinical findings that overlap with stroke mimics and anterior circulation ischemia, making diagnosis more heavily dependent on imaging. Recanalization is an important predictor of improved functional outcome and survival. In this endovascular era, trials of BAO are fraught with deterrents to enrollment. Despite limitations, endovascular treatment has shown improved outcome in select patients.

Early Neurological Deterioration Despite Recanalization in Basilar Artery Occlusion Treated by Endovascular Therapy.

Background: We aim to identify the risk factors of early neurological deterioration (END) despite successful recanalization and explore the association of END with 90-day outcomes in acute basilar artery occlusion (BAO) treated by endovascular therapy (EVT).Methods: A prospectively registered consecutive cohort of BAO patients with successful recanalization by EVT in a tertiary stroke center during a 6-year period was reviewed. END was defined as an National Institutes of Health Stroke Scale (NIHSS) score increase ≥4 points, or death, from baseline to 24 h after EVT. Multivariate logistic regression analysis was used to identify the risk factors of END. The 90-day outcomes between END and non-END groups were compared by Pearson's χ2 test.Results: END was observed in 21 of 148 patients included in this study. Multivariate logistic regression analysis showed that patients with progressive or fluctuating symptoms had a higher risk of END than those with symptoms of acute attack (OR 5.52, 95% CI 1.73–17.63), and NIHSS score and puncture-to-recanalization time (PTR), as continuous variables, were also significantly associated with END. Using a generalized additive model with spline smoothing function, we observed a linear relationship between PTR (increased by 1 h) and END (OR 2.57, 95% CI 1.45–4.57), and a non-linear relationship between NIHSS score and END. Only when the NIHSS score was ≥23 points was it related to END (OR 0.7, 95% CI 0.6–0.9). In addition, patients with END had a lower proportion of 90-day favorable outcome (19.0 vs. 59.1%, p < 0.01) and higher mortality (33.3 vs. 13.4%, p = 0.048) than those with non-END.Conclusion: Mode of stroke onset, NIHSS score, and PTR may help to identify BAO patients with a higher risk of END after EVT. Moreover, END may affect the 90-day outcomes of these patients.

A Pre-Intervention 4-Item Scale for Predicting Poor Outcome Despite Successful Recanalization in Basilar Artery Occlusion.

Poor outcome despite successful recanalization is a relatively common occurrence after endovascular therapy (EVT) in acute intracranial large vessel occlusion. We aimed to develop a simple pre-intervention scale with readily available indicators for predicting the 90-day poor outcome in acute basilar artery occlusion (BAO) patients with successful recanalization after EVT. A prospectively registered consecutive cohort of acute BAO patients treated with EVT in a tertiary stroke center during a 6-year period was reviewed. Poor outcome despite successful recanalization was defined as a 90-day mRS of > 3 despite a post-intervention mTICI of ≥ 2b. A logistic regression analysis was employed to develop the predictive scale. The performance of the scale was estimated by ROC curve and Hosmer-Lemeshow test. Poor outcome was observed in 48 of 109 patients included in this study. The proposed scale consisted of four selected pre-intervention predictors, including the NIHSS score, Pons-Midbrain Index (PMI), bilateral thalamic infarction, and Basilar Artery on Computed Tomography Angiography (BATMAN) collateral score. The 4-item scale revealed good discrimination with an area under curve of 0.83 (95% CI = 0.75-0.90) and acceptable calibration assessed by Hosmer-Lemeshow test (P = 0.48). The optimal cutoff value of the scale (range 0-5 points) was ≥ 3 points with 77% sensitivity, 80% specificity, and 79% accuracy. As a pre-intervention predictive model, the 4-item scale has promising predictive value for poor outcome despite successful recanalization in BAO patients treated with EVT. Nevertheless, external validation with blinded outcome is still needed to confirm its performance before clinical application.

Value of Posterior circulation ASPECTS and Pons-Midbrain Index on non-contrast CT and CT Angiography Source Images in patients with basilar artery occlusion recanalized after mechanical thrombectomy

PurposeEndovascular treatment with mechanical thrombectomy devices demonstrated high recanalization rates but functional outcome did not correlate with high rates of recanalization obtained. Patient selection prior to the endovascular treatment is very important in the final outcome of the patient. The primary aim of our study was to evaluate the prognostic value of posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and Pons-Midbrain Index (PMI) scores in patients with Basilar Artery Occlusion (BAO) treated with successful angiographic recanalization after mechanical thrombectomy. MethodsRetrospective single-centre study including 18 patients between 2008 and 2013 who had acute basilar artery occlusion managed with endovascular treatment within 24h from symptoms onset and with successful angiographic recanalization. The patients were initially classified into two groups according to clinical outcome and mortality at 90 days. For analysis we also divided patients into groups based on pc-ASPECTS (≥8 vs. <8) and PMI (≥3 vs. <3) on non-contrast CT (NCCT) and CT Angiography Source Images (CTASI). Imaging data were correlated to clinical outcome and mortality rate. ResultsCTASI pc-ASPECTS, dichotomized at <8 versus ≥8, was associated with a favourable outcome (RR: 2.6; 95% CI: 1.3–5.2) and a reduced risk of death (RR: 6.5: 95% CI: 7.8–23.3). All patients that survived and were functionally independent had pc-ASPECTS score ≥8. None of the 5 patients with CTASI pc-ASPECTS score less than 8 survived. ConclusionPC-ASPECTS on CTASI is helpful for predicting functional outcome after BAO recanalization with endovascular treatment. These results should be validated in a randomised controlled trial in order to decide whether or not to treat a patient with BAO.

Valor de la escala ASPECTS de circulación posterior y del índice puente-mesencéfalo en imágenes de TC sin contraste y angiografía por TC en pacientes con oclusiones de la arteria basilar recanalizados tras trombectomía mecánica

PurposeEndovascular treatment with mechanical thrombectomy devices demonstrated high recanalization rates but functional outcome did not correlate with high rates of recanalization obtained. Patient selection prior to the endovascular treatment is very important in the final outcome of the patient. The primary aim of our study was to evaluate the prognostic value of posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and Pons-Midbrain Index (PMI) scores in patients with Basilar Artery Occlusion (BAO) treated with successful angiographic recanalization after mechanical thrombectomy. MethodsRetrospective single-center study including 18 patients between 2008 and 2013 who had acute basilar artery occlusion managed with endovascular treatment within 24hours from symptoms onset and with successful angiographic recanalization. The patients were initially classified into two groups according to clinical outcome and mortality at 90 days. For analysis we also divided patients into groups based on pc-ASPECTS (≥8vs.<8) and PMI (≥3vs.<3) on non-contrast CT (NCCT) and CT Angiography Source Images (CTASI). Imaging data were correlated to clinical outcome and mortality rate. ResultsCTASI pc-ASPECTS, dichotomized at <8 versus≥8, was associated with a favorable outcome (RR: 2.6; 95% CI: 1.3-5.2) and a reduced risk of death (RR: 6.5: 95% CI: 7.8-23.3). All patients that survived and were functionally independent had pc-ASPECTS score≥8. None of the 5 patients with CTASI pc-ASPECTS score less than 8 survived. ConclusionPC-ASPECTS on CTASI is helpful for predicting functional outcome after BAO recanalization with endovascular treatment. These results should be validated in a randomized controlled trial in order to decide whether or not to treat a patient with BAO.

Abstract WMP17: Time to Treatment, Collaterals and Recanalization in Basilar Artery Occlusion: Which Factors Determine Prognosis?

Background: Whether radiological factors influence the effect of time to recanalization on outcome in basilar artery occlusion (BAO) is uncertain. We evaluated the association between onset time to treatment (OTT), radiological prognostic factors (presence of collaterals and extent of the occlusion) and clinical outcome in endovascular BAO patients. Methods: Clinical and radiological data of consecutive endovascular-treated stroke patients with BAO diagnosed on CT angiography at Royal Melbourne Hospital (Australia), Royal Adelaide Hospital (Australia), University Hospital of Tor Vergata (Rome, Italy) and from the international BASICS registry were retrospectively analysed. The Basilar Artery on Computed Tomography Angiography (BATMAN) score and Posterior Circulation Collateral Score (PC-CS) were assessed by two investigators blinded to clinical outcome. Previously validated dichotomies for favorable BATMAN score (≥7) or PC-CS (≥6) were used. Good outcome was defined as modified Rankin Scale≤3 within 3 months; successful reperfusion as mTICI 2b-3 (or TIMI 2-3 in BASICS). Results: We included 155 BAO patients treated with intra-arterial urokinase and/or mechanical thrombectomy (86 with mechanical thrombectomy): mean(SD) age 65(14), median NIHSS 22 (IQR 12-30), median OTT 348.5 min [(IQR 246-480), 37% treated beyond 6hours]. In logistic regression adjusted for age and NIHSS, OTT&gt;6h was associated with poor outcome (OR 3.0, 95%CI 1.4-6.6, p=0.006) but this association was only present in the subgroup with unfavourable BATMAN score (adjusted OR 4.6, 95%CI 1.7-12, p=0.002) or PC-CS (3.7, 95%CI 1.3-11, p=0.02) and not in those with favorable BATMAN score (adjusted OR 0.7, 95%CI 0.2-3.6, p=0.7) or PC-CS (2.7, 95%CI 0.6-12, p=0.2). When successful reperfusion was added to the model with age and NIHSS, OTT&gt;6h remained significantly associated with poor outcome in patients with unfavorable BATMAN score (OR 5.0, 95%CI 1.8-14, p=0.002) or PC-CS (4.5, 95%CI 1.4-14, p=0.01), but not in patients with favorable BATMAN score (OR 1.6, 95%CI 0.2-13, p=0.6) or PC-CS (3.2, 95%CI 0.6-17, p=0.2). Conclusions: BAO patients with good collaterals and less extensive occlusion may have good outcome if recanalization is achieved even in a delayed time window.

Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child

Endovascular treatment of acute ischemic stroke in children is increasingly being reported, although the time window for intervention is unclear. We describe a previously healthy 17-month-old child who presented with...

Late recanalization of basilar artery occlusion in a previously healthy 17-month-old child

Endovascular treatment of acute ischemic stroke in children is increasingly being reported, although the time window for intervention is unclear. We describe a previously healthy 17-month-old child who presented with...

Time window for recanalization in basilar artery occlusion: Speculative synthesis.

Basilar artery occlusion (BAO) is one of the most devastating forms of stroke and few patients have good outcomes without recanalization. Most centers apply recanalization therapies for BAO up to 12-24 hours after symptom onset, which is a substantially longer time window than the 4.5 hours used in anterior circulation stroke. In this speculative synthesis, we discuss recent advances in BAO treatment in order to understand why and under which circumstances longer symptom duration might not necrotize the brainstem and turn therapeutic attempts futile. We raise the possibility that distinct features of the posterior circulation, e.g., highly developed, persistent collateral arterial network, reverse filling of the distal basilar artery, and delicate plasma flow siding the clot, might sustain brittle patency of brainstem perforators in the face of stepwise growth of the thrombus. Meanwhile, the tissue clock characterizing the rapid necrosis of a typical anterior circulation penumbra will not start. During this perilous time period, recanalization at any point would salvage the brainstem from eventual necrosis caused by imminent reinforcement and further building up of the clot.

Abstract W MP10: Outcome and Futile Recanalization in Basilar Artery Occlusion - Systematic Analysis

Background: Basilar artery occlusion (BAO) is a most devastating form of stroke, and the current wisdom is to reverse it with revascularization therapies. Pharmacological thrombolysis have been adjuncted or replaced with endovascular thrombectomy devices. The preferred approach remains unknown and most recanalizations are futile with no clinical benefit. Methods: To determine whether invasive, endovascular interventions are superior to pharmacological thrombolysis alone we analyzed systematically the reported outcomes produced by variable BAO recanalization protocols. Information was retrieved from 15 reports published from 2005 comprising 803 patients in 17 cohorts. In the largest single-center cohort (162, Helsinki), predictors of futile recanalization (FR;3-month modified Rankin Scale [mRS] score 4 to 6) were determined. Results: Good outcome was reported by pharmacological protocols less frequently than by mechanical approaches either alone or on-demand (24.4% vs. 35.5% %, p&lt;0.001), accompanied by lower recanalization rates (70.9% vs. 84.1%, p&lt;0.001)(Figure). Afforded by superior recanalization rate at 91%, good outcome was reached by primary thrombectomy with stent-retrievers in 36%, but at the cost of substantial FR rate at 60%. In the largest single-center cohort, the single most significant predictor was extensive baseline ischemia, increasing the odds of futility 20-fold (95%CI 4.39-92.29, p&lt;0.001). Other attributes of futility were ventilation support and history of atrial fibrillation or previous stroke. Conclusion: Mechanical endovascular approaches have reported superior primary outcome rates over pharmacological thrombolysis in BAO. Stricter patient selection, most notably to exclude victims of already extended ischemia, would assist in translating excellent recanalization rates into improved clinical outcomes and more acceptable futility rates.

Endovascular treatment of acute basilar artery occlusion

Endovascular treatment of acute basilar artery occlusion

Optimized amide proton transfer imaging of ischemic stroke

Optimized amide proton transfer imaging of ischemic stroke

Thrombolysis of basilar artery occlusion: Impact of baseline ischemia and time

To evaluate the impact of extensive baseline ischemic changes on functional outcome after thrombolysis of basilar artery occlusion (BAO), and to study the effect of time to treatment in the absence of such findings. We prospectively evaluated 184 consecutive patients with angiography-proven BAO. The majority of patients received intravenous alteplase and concomitant full-dose heparin. Extensive baseline ischemia was defined as posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) < 8. Onset-to-treatment time (OTT) was evaluated both as a continuous and as a categorical variable (0-6 hours, 6-12 hours, 12-24 hours, and 24-48 hours). Successful recanalization means thrombolysis in myocardial infarction (TIMI) = 2 to 3. Symptomatic intracranial hemorrhage (sICH) was evaluated with National Institute of Neurological Disorders and Stroke, European Cooperative Acute Stroke Study II, and Safe Implementation of Thrombolysis in Stroke criteria. Poor 3-month outcome was defined as modified Rankin Scale score of 3 to 6. The majority (96%) of patients with baseline pc-ASPECTS < 8 had poor 3-month outcome, and a similar number (94%) was observed in those of them with confirmed recanalization (51.5%). In contrast, half of the patients with pc-ASPECTS ≥ 8 and successful recanalization (73.2%) achieved good outcome. In these patients, OTT was associated with poor outcome neither as a continuous nor as a categorical variable. Factors independently associated with poor outcome were greater age and baseline National Institutes of Health Stroke Scale, lack of recanalization, history of atrial fibrillation, and sICH. In the model including the whole cohort (patients with any pc-ASPECTS), pc-ASPECTS < 8 was independently associated with poor outcome (odds ratio = 5.83, 95% confidence interval = 1.09-31.07). In the absence of extensive baseline ischemia, recanalization of BAO up to 48 hours was seldom futile and produced good outcomes in 50% of patients, which was independent of time to treatment.

Abstract TMP1: Infarct Location And Volumes As Predictors Of Outcome After Endovascular Recanalization Of Basilar Artery Occlusion

Background and Purpose: Prognostic information after endovascular recanalization of basilar artery occlusion is important for guiding aggressiveness of subsequent care. While final infarct volumes have been shown to correlate with outcomes in anterior circulation strokes, no such relationship has been described in basilar artery occlusions. We sought to determine the relationship between the volume of final infarction, location of infarction and outcome of clinical course in patients treated with endovascular therapy for basilar artery occlusion at our institution. Methods: A retrospective review of our prospectively maintained endovascular stroke database identified 103 patients of which 59 patients underwent post treatment MRI. Automated software was used to measure infarct volume. Results: Patients included in the study had the following features: mean age 61, mean NIHSS 20, female 24%. Successful recanalization (TIMI 2/3) occurred in 53/59 patients (90%). Infarcts were divided into topographic regions (see Table). Good outcomes (mRS 0-2 at 3 months) were achieved in 32% of patients. 71% of patients with no brainstem infarct had a good outcome (p=0.03). 46% of patients with no thalamic infarct had a good outcome (p=0.049). In multivariate analysis, independent predictors of good outcomes were brainstem infarct volume (OR 0.25, 95% CI 0.11-0.61, p=0.002) and age (OR 0.84, CI 0.74-.91, p=0.0018). Patients with good outcomes had a mean brainstem infarct volume of 1.45 cc, while patients with poor outcomes had a mean brainstem infarct volume of 6 cc (p=0.002). Conclusions: Rate of good outcomes after recanalization of basilar artery occlusion is 32%. Presence and volume of brainstem infarct, presence of thalamic infarct and patient age are the strongest predictors of outcome. Further studies will address whether these parameters can be used prospectively in prognosticating outcomes after basilar artery occlusive disease.

Abstract WMP24: Thrombolysis within 48 hours after Basilar Artery Occlusion

Introduction: Recanalization therapies and their time window in basilar artery occlusion (BAO) remain empirical and vary among hospitals. Our institutional protocol for BAO does not follow the strict RCT-guided guidelines in hemispheric stroke, and advices thrombolysis up to 12 hours after sudden onset of severe symptoms, and 48 hours after onset of gradually progressing symptoms, provided that extensive infarction changes have not yet occurred. Objective: The aim was to analyse the importance of two fundamental variables, symptom duration and the extent of baseline infarction, on the outcome of thrombolysis-treated BAO. Methods: We prospectively gathered data from 184 consecutive patients with angiography-proven BAO in the Helsinki University Central Hospital, which receives all candidates for stroke thrombolysis in a catchment area of 1.5 million. We took advantage of frequent non-adherence to our management protocol and grouped patients according to "protocol violations" (PVs): exceeded symptom duration (time PV) and large-infarct PV. Patients were divided into 4 categories based on onset-to-treatment time (OTT). Intravenous alteplase (0.9 mg/kg) and concomitant full-dose heparin was administered in the majority of patients. Outcome variables were recanalization of BA, 3-month modified Rankin Scale (mRS) and 1-year mortality. Results: Patients with no PV had the best outcome (when recanalized, 51% had good outcome [mRS 0-2], and 62% were non-dependent [mRS 0-3]), followed by patients with time PV (42% and 58%, respectively). Over 90% of patients with large-infarct PV were dependent, institutionalized, or dead (mRS 4-6), even when recanalized. Compared with 37% in patients with no PV, 1-year mortality was higher in patients with both PVs (68.8%, p&lt;0.05) and large-infarct PV (64.7%, p&lt;0.01); but similar to patients with time PV (45.5%, p=0.61). Importantly, the outcome of recanalized BAO was similar among OTT categories. Conclusions: In the absence of extensive baseline infarct signs, recanalization of BAO up to 48 hours was seldom futile (mRS 4-6) and produced non-dependent outcomes in 60% of patients, which was virtually independent of the exact time window. We recommend a dedicated protocol for BAO in stroke patients screened for thrombolysis.

Current treatment of basilar artery occlusion

Basilar artery occlusion (BAO) is associated with high mortality (85-95%) if recanalization does not occur. Evidence of the efficacy of different therapy protocols of intravenous thrombolysis (IVT) or intraarterial thrombolysis (IAT) and/or mechanical endovascular treatment is based on retrospective or prospective patient cohorts, since randomized controlled trials (RCTs) do not exist. Roughly a third of BAO patients reach independent outcome following thrombolysis. From those in whom recanalization occurs, about half will reach independence. In noninvasive and endovascular protocols, recanalization of BAO is reached in 60-85% of the patients. While invasive endovascular approaches afford greater recanalization rates, they have not been proven superior to IVT in terms of functional outcome. Meaningful survival after BAO requires rapid access to thrombolysis. "Bridging" protocols have been introduced where rescue therapies such as endovascular thrombolysis and on-demand mechanical thrombectomy or angioplasty are used. Multimodal imaging techniques should be used to choose the best therapeutic option individually.

Interventional Therapy for Acute Ischemic Stroke Is Associated with Poor Outcomes (P05.214)

Objective: To determine patient populations that benefit from intra-arterial (IA) interventional therapy for acute ischemic stroke. Background IA therapy is becoming more frequently used, but outcome data and predictors of good outcome are limited. Design/Methods: Retrospective analysis of patients treated at a single stroke center between 2006-2010. Demographic, laboratory, and clinical data were retrospectively collected. Admission and discharge NIH stroke scale (NIHSS) and modified Rankin Scale (mRS) were recorded. When missing, scores were retrospectively calculated. Imaging characteristics, such as ASPECT score, vessel occlusion, post-treatment hemorrhage, and time to treatment were identified. A poor outcome was defined as mRS ≥3. Results: We identified 66 patients; 42% were women, 47% African-American. Mean age was 63(±16) (range: 27-87) years. All patients had pre-stroke mRS of ≤2. Median pre-treatment NIHSS was 21.5 (range:10-38). On baseline CT scan, mean ASPECTS score was 9(±1.1). ASPECTS score on CTA source images and the non-contrast scan did not correlate (r 2 =0.21). Before IA therapy, IV tPA was administered in 29/66 (44%) patients; treatment with IV tPA did not correspond with discharge mRS ≤3 (p=0.54). Stroke onset-IA treatment interval was 355 (±194) minutes; time to treatment and discharge mRS did not correlate (r 2 =0.02). Median discharge NIHSS of surviving patients was 11 (range: 0-26). Discharge mRS was ≥3 in 89% of patients, including 21 (32%) of 66 patients who died. Hypotension (SBP Conclusions: Interventional therapy for acute ischemic stroke is likely to produce poor outcomes (mRS ≥3) at discharge. Recanalization of basilar artery occlusion usually results in improved outcomes. Pre-treatment with IV tPA may make no significant difference in early neurological recovery. Further study of this topic is needed. Disclosure: Dr. Simpson has nothing to disclose. Dr. Marin has nothing to disclose. Dr. Penstone has nothing to disclose. Dr. Mitsias has nothing to disclose.

Intraarterial Thrombolysis and Stent Placement for Acute Basilar Artery Occlusion

To study retrospectively the prognostic factors for acute basilar artery occlusion treated with intraarterial thrombolysis and stent placement. Within 3-48 hours of disease onset, 52 patients with basilar artery occlusion were treated with emergency intraarterial thrombolysis with recombinant tissue plasminogen activator (rtPA) or urokinase (UK) or intraarterial thrombolysis combined with stent placement. Sixteen patients simultaneously received stent placement for the partial recanalization of basilar artery occlusion after intraarterial thrombolysis. The National Institutes of Health Stroke Scale (NIHSS) scores and the modified Rankin Scale (mRS) scores of the patients were estimated. A favorable clinical outcome occurred in 22 patients (42.3%), and 20 patients (38.5%) died. The survival rate was 61.5% (32 patients). Successful recanalization of basilar artery occlusion was achieved in 24 patients (46.2%), and partial recanalization was achieved in 16 patients (30.7%). The rate of recanalization was 76.9%. NIHSS scores less than 14, treatment time window less than 24 hours, and a good recanalization were markedly correlated with good clinical prognosis. NIHSS scores less than 14 and treatment time window less than 24 hours were significantly correlated with recanalization. NIHSS scores less than 14 and good recanalization could act as independent predictors for clinical prognosis. NIHSS scores less than 14 on admission and successful recanalization can predict favorable outcome for patients with basilar artery occlusion. This study shows that intraarterial thrombolysis and stent placement may be a useful treatment for acute basilar artery occlusion.

Endovascular treatment of basilar artery occlusion by manual aspiration thrombectomy

Background and purposeBasilar artery occlusion remains one of the most devastating subtypes of stroke. Intravenous and intra-arterial therapy have altered the natural history of this disease; however, clinical results remain...

Brain Stem Diffusion-Weighted Imaging Lesion Score: A Potential Marker of Outcome in Acute Basilar Artery Occlusion

The benefit of recanalization in basilar artery occlusion (BAO) has been established. The baseline extent of brain stem damage may also influence the outcome. We investigated whether a baseline diffusion-weighted imaging (DWI) score may provide additional prognostic value in BAO. We analyzed baseline clinical and DWI parameters in consecutive patients treated with endovascular procedures for acute BAO. Brain stem DWI lesions were assessed by using a semiquantitative score based on arterial territory segmentation. Outcome at 3 months was dichotomized according to the modified Rankin Scale (mRS) as favorable (mRS, 0-2) or unfavorable (mRS, 3-6). Spearman rank correlation tests assessed the correlation between DWI and clinical variables. Univariate and multivariate logistic regression analyses were used to identify clinical and MR imaging predictors of outcome. Twenty-nine patients were included. The brain stem DWI score (median, 3; range, 0-14) was correlated with the baseline National Institutes of Health Stroke Scale (NIHSS) score and the presence and length of coma (r = 0.67, 0.49, and 0.53, respectively; P < .01). Recanalization was achieved in 76%. A higher baseline NIHSS score (P = .02) and brain stem DWI score (P = .03), a lower Glasgow Coma Scale score (P = .04), and the presence of coma (P = .05) were associated with poor outcome in univariate analysis. Multivariate analysis showed that the brain stem DWI score was the only independent baseline predictor for clinical outcome (P = .026). Baseline brain stem DWI lesion score is an independent marker of outcome in BAO.