Introduction Basilar artery occlusions (BAO) are associated with very high morbidity and mortality owing to the eloquent supply of the brainstem and midbrain. Despite the positive endovascular trials for anterior circulation acute ischemic stroke, there remains a clear lack of consensus regarding the optimal method of patient selection for IA treatment especially in the posterior circulation (PC).
We evaluated the baseline NCCT PC-ASPECTS as well as DWI brainstem scores in acute ischemic stroke patients with BAO prior to IA treatment and their association with final functional outcomes.
Methods A retrospective study was performed on consecutive cases of basilar stroke patients presenting in the acute setting (<12 h). The inclusion criteria included: presentation <12 h from symptom onset, CTA/MRA verified BAO, and pre-treatment imaging with NCCT and MR DWI. Patient demographics, medical comorbidities, time from symptom onset to recanalization, final recanalization (TICI scale), and clinical outcomes (90 day mRS score) were obtained, accordingly. Two neuroradiologists conducted blinded scoring of PC-ASPECTS for all baseline NCCT based on previously published method.1 One observer evaluated these baseline MR-DWI studies for brainstem infarcts based on previously published scoring system.2 PC-ASPECTS were dichotomized into ≥8 (favorable) and <8 (unfavorable)1 and brainstem DWI was dichotomized to <3 (favorable) and ≥3 unfavorable for primary analysis.2 Chi-square, Mann-Whitney U, student t test, and Pearson correlation coefficient (r) were used for univariate analyzes as appropriate. For evaluation of inter-rater reliability, Intraclass Correlation Coefficient (ICC) was used. A P value of 0.05).
Results Thirty four patients (12 F/22 M; mean age of 63.36 ± 15.48 years) were studied. Among 34 cases, 27 were selected based on CT and MR DWI. Interobserver agreement for baseline PC-ASPECTS assigned to the baseline CT studies was excellent (ICC = 0.93). The median PC-ASPECTS and DWI brainstem scores were 8 and 1.5, respectively. Eighteen out of 34 patients (53%) had baseline favorable PC-ASPECTS. Among 27 cases baseline MR studies, 18 (66%) cases had favorable DWI brainstem scores. A significant fair inverse correlation was observed between PC-ASPECTS and DWI brainstem scores (r = - 0.43, P = 0.02). Both favorable and unfavorable PC-ASPECTS and DWI brainstem score groups were comparable in baseline characteristics, medical history, time from symptom onset to recanalization (P > 0.05). Thirteen patients (38%) achieved final good functional outcome. Successful recanalization (TICI 2b, 3) rate was 88% (n = 30); however it was not associated with good functional outcomes (P < 0.68). Neither PC-ASPECTS nor DWI brainstem scores were predictor of good functional outcome (P = 0.31, P = 0.61, respectively).
Conclusion Favorable baseline PC-ASPECTS and DWI brainstem scores were observed in acute basilar ischemic stroke patients prior to IA therapy; however, neither technique was able to predict good functional outcomes.
Puetz V, et al. Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 2008;39(9):2485–90
Mourand I, et al. Diffusion-weighted imaging score of the brain stem: A predictor of outcome in acute basilar artery occlusion treated with the Solitaire FR device. AJNR Am J Neuroradiol 2014;35(6):1117–23
Disclosures F. Syed: None. A. Honarmand: None. D. Ban: None. A. Elmokadem: None. V. Daruwalla: None. M. Hurley: None. A. Shaibani: None. S. Ansari: None.
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