scholarly journals Functional Independence following Endovascular Treatment for Basilar Artery Occlusion despite Extensive Bilateral Pontine Infarcts on Diffusion-Weighted Imaging: Refuting a Self-Fulfilling Prophecy

2016 ◽  
Vol 5 (3-4) ◽  
pp. 179-184 ◽  
Author(s):  
Diogo C. Haussen ◽  
Renato A.C. Oliveira ◽  
Vikas Patel ◽  
Raul G. Nogueira
Keyword(s):  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Treatment Decision ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Decision Algorithm ◽  
Operator Experience ◽  
Diffusion Weighted

Background and Purpose: Extensive brainstem diffusion-weighted imaging (DWI) hyperintensity has been associated with poor outcomes. We aim at documenting a series of patients with extensive DWI pontine lesions who achieved independence following endovascular therapy and aggressive medical therapy in the setting of posterior circulation basilar artery occlusion (BAO). Methods: This is a retrospective endovascular database review of a single-operator experience over a 9-year period for patients with (1) complete BAO, (2) extensive bilateral pontine DWI changes and (3) 90-day modified Rankin scale 0-2. Results: Three out of a total of 40 patients met the inclusion criteria. Case 1 was an 18-year-old male with National Institutes of Health Stroke Scale (NIHSS) 32 on admission, treated 25 h after symptom onset. Case 2 was a 56-year-old male with NIHSS 19, treated 10 h after onset. Case 3 was a 73-year-old male with NIHSS 29, treated 6 h after onset. Full endovascular reperfusion was achieved in all 3 patients. A literature review identified 9 additional cases of extensive pontine DWI changes and good outcome. These patients were young (32 ± 22 years), mostly males (69%), presented with a relatively low posterior circulation Acute Stroke Prognosis Early CT Score (6 ± 1), were treated relatively late from last known normal (13 ± 10 h) and were mostly (84%) treated with endovascular intervention. Conclusion: Extensive bilateral pontine DWI lesions among patients with BAO are not an unequivocal indicator of poor prognosis. We advise strong caution when considering these findings in the treatment decision algorithm.

Novel Diffusion-Weighted Imaging Score Showed Good Prognostic Value for Acute Basilar Artery Occlusion Following Endovascular Treatment: The Pons-Midbrain and Thalamus Score

Stroke ◽  
2021 ◽  
Author(s):  
Lian Liu ◽  
Meiping Wang ◽  
Yiming Deng ◽  
Gang Luo ◽  
Xuan Sun ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Brain Stem ◽  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Good Outcome ◽  
Diffusion Weighted

Background and Purpose: Prognostic factors for outcome of endovascular treatment remains to be investigated in patients with acute basilar artery occlusion. We aimed to assess the prognostic value of a novel pretreatment diffusion-weighted imaging score: The Pons-Midbrain and Thalamus (PMT) score. Methods: Eligible patients who underwent endovascular treatment due to acute basilar artery occlusion were reviewed. The PMT score was a diffusion-weighted imaging–based semiquantitative scale in which the infarctions of pons, midbrain, and thalamus were fully considered. The PMT score was assessed as well as the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score and Brain Stem Score. Good outcomes were defined as a modified Rankin Scale score of ≤3 at 90-day and successful reperfusion as Thrombolysis in Cerebral Infarction grades 2b/3. The associations between baseline clinical parameters and good outcomes were evaluated with logistic regression. Results: A total of 107 patients with pretreatment magnetic resonance imaging were included in this cohort. The baseline PMT score (median [interquartile range], 3 [1–5] versus 7 [5–9]; P <0.001) and Brain Stem Score (median [interquartile range], 2 [1–4] versus 3 [2–5]; P =0.001) were significantly lower in good outcome group; the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was higher in good outcome group without statistical significance. As a result of receiver operating characteristic curve analyses, the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score showed poor prognostic accuracy for good outcome (area under the curve, 0.60 [95% CI, 0.49–0.71]; P =0.081); The baseline PMT score showed significantly better prognostic accuracy for 90-day good outcome than the Brain Stem Score and National Institutes of Health Stroke Scale (area under the curve, 0.80 versus 0.68 versus 0.78, P =0.003). In addition, favorable PMT score <7 (odds ratio, 22.0 [95% CI, 6.0–80.8], P <0.001), Brain Stem Score <3 (odds ratio, 4.65 [95% CI, 2.05–10.55], P <0.001) and baseline National Institutes of Health Stroke Scale <23 (odds ratio, 8.0 [95% CI, 2.5–25.6], P <0.001) were associated with improved good outcome. Conclusions: In patients with acute basilar artery occlusion following endovascular treatment, the pretreatment diffusion-weighted imaging based PMT score showed good prognostic value for clinical outcome.

scholarly journals Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3454-3459 ◽  
Author(s):  
Volker Puetz ◽  
Andrei Khomenko ◽  
Michael D. Hill ◽  
Imanuel Dzialowski ◽  
Patrik Michel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Ct Angiography ◽  
Basilar Artery ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Scale Scores

Background and Purpose— The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). Methods— BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus <8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2). Results— Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS <8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS ≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus <6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5). Conclusions— pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.

Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion

2015 ◽  
Vol 8 (8) ◽  
pp. 783-786 ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Chris Nickele ◽  
Vinodh T Doss ◽  
Dan Hoit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Basilar Artery ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Stroke Severity ◽  
Nihss Score

IntroductionThe natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion.ObjectiveTo examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT.MethodsWe conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0–2 at 3 months.ResultsA total of 21 patients with AIS due to BAO (age range 31–84 years, median admission NIHSS score: 18 points, range 2–38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)).ConclusionsThe presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT.

Predictive value on diffusion weighted imaging scores for basilar artery occlusion after endovascular treatment

2020 ◽  
pp. 159101992094051
Author(s):  
Can Wan ◽  
Guangliang Wu ◽  
Xing Jin ◽  
Shaojun Liao ◽  
Foming Zhang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Predictive Value ◽  
Odds Ratio ◽  
Diffusion Weighted Imaging ◽  
Area Under The Curve ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Diffusion Weighted

Purpose To assess the predictive value of three scoring systems based on diffusion weighted imaging in basilar artery occlusion patients after endovascular treatment. Methods We analyzed clinical and radiological data of patients with basilar artery occlusion from January 2010 to June 2019, with modified Rankin Scale of 0–2 and 3–6 defined as favorable outcome and unfavorable outcome at three months. Diffusion weighted imaging posterior circulation ASPECTS Score (DWI pc-ASPECT Score), Renard diffusion weighted imaging Score, and diffusion weighted imaging Brainstem Score were used to evaluate the early ischemic changes. Results There were a total of 88 basilar artery occlusion patients enrolled in the study after endovascular treatment, with 33 of them getting a favorable outcome. According to the analysis, the time from onset to puncture within 12 h (odds ratio: 4.34; 95% confidence interval: 1.55–12.16; P = 0.01), presence of collateral flow via PCoA (odds ratio: 0.31; 95%CI: 0.12–0.79; P = 0.01) or between PICA and SCA (odds ratio: 0.18; 95%CI: 0.07–0.47; P = 0.00), equal or less than 15 points on baseline NIHSS (area under the curve 0.79, 95% CI 0.69–0.89; sensitivity = 69.1%, specificity = 81.8%; P = 0.00), and equal or less than 1.5 points on diffusion weighted imaging Renard score (area under the curve 0.63, 95% CI 0.51–0.75; sensitivity = 83.6%, specificity = 39.4%; P = 0.046) were independently associated with favorable outcome. Conclusions Renard diffusion weighted imaging score may be an independent predictor of functional outcome in basilar artery occlusion patients after endovascular treatment.

scholarly journals A Simplified NIH Stroke Scale for Acute Basilar Artery Occlusion Treated with Endovascular Therapy

2020 ◽  
Author(s):  
Xu Tong ◽  
Jiayi An ◽  
Raynald Liu ◽  
Xuan Sun ◽  
Feng Gao ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Endovascular Therapy ◽  
Interobserver Reliability ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Predictive Tool ◽  
Assessment Time ◽  
Stroke Center

Abstract Background To design a simplified NIH Stroke Scale (sNIHSS) that requires minimal training but can reflect acute basilar artery occlusion (BAO) severity and is predictive for the 90-day outcome after endovascular therapy (EVT). Methods We analyzed the prospectively gathered data of acute BAO treated with EVT in a tertiary stroke center during a 6-year period. The sNIHSS (range: 0 to 20 points) consisted of 4 NIHSS items: level of consciousness - (1) questions and (2) commands; motor function - (3) arms and (4) legs. The 90-day outcomes included functional independence (mRS ≤ 2), favorable outcome (mRS ≤ 3) and death. Results Of 173 patients, 62, 83 and 36 achieved functional independence, favorable outcome and death, respectively. Interobserver reliability of sNIHSS was high (ICC = 0.95), and compared with NIHSS, sNIHSS had a significant reduction of assessment time (median: 1.5 min vs. 5 min, P < 0.01). A multivariable logistic model demonstrated that sNIHSS was independently associated with functional independence (OR = 0.82, 95% CI = 0.77-0.87), favorable outcome (OR = 0.86, 95% CI = 0.81-0.92) and death (OR = 1.24, 95% CI = 1.12-1.37). Additionally, the sNIHSS predicted 90-day outcomes almost as same discrimination as NIHSS by using DeLong test. The optimal cutoff value of sNIHSS was determined to be 12 points for predicting any outcome. Conclusions The sNIHSS reflects acute BAO severity well and predicts 90-day outcomes with reasonable accuracy. Nevertheless, the sNIHSS needs further validation before it can be applied as a predictive tool for acute BAO outcome.

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