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Original research
DWI cerebellar infarct volume as predictor of outcomes after endovascular treatment of acute basilar artery occlusion
  1. Isabelle Mourand1,
  2. Mehdi Mahmoudi2,
  3. Cyril Dargazanli2,
  4. Frederique Pavillard3,
  5. Caroline Arquizan1,
  6. Julien Labreuche4,
  7. Imad Derraz2,
  8. Nicolas Gaillard1,
  9. Genevieve Blanchet-Fourcade5,
  10. Pierre Henri Lefevre2,
  11. Yassine Boukriche6,
  12. Gregory Gascou2,
  13. Lucas Corti1,
  14. Vincent Costalat2,
  15. Emmanuelle Le bars2,
  16. Federico Cagnazzo2
  1. 1Neurology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
  2. 2Neuroradiology, University Hospital Center Montpellier, Montpellier, Languedoc-Roussillon, France
  3. 3Reanimation, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
  4. 4Biostatistics, University Hospital Center Lilles, Lilles, France
  5. 5Neurology, Hospital Center Narbonne, Narbonne, Languedoc-Roussillon, France
  6. 6Neurology, Hospital Center Beziers, Beziers, Languedoc-Roussillon, France
  1. Correspondence to Dr Isabelle Mourand, Neurology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France; i-mourand{at}chu-montpellier.fr

Abstract

Background Preprocedural predictors of outcome in patients with acute basilar artery occlusion (ABAO) who have undergone endovascular treatment (EVT) remain controversial. Our aim was to determine if pre-EVT diffusion-weighted imaging cerebellar infarct volume (CIV) is a predictor of 90-day outcomes.

Methods We analyzed consecutive MRI-selected endovascularly treated patients with ABAO within the first 24 hours after symptom onset. Successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction score of 2b–3. Using the initial MRI, baseline CIV was calculated in mL on an apparent diffusion coefficient map reconstruction (Olea Sphere software). CIV was analyzed in univariate and multivariable models as a predictor of 90-day functional independence (modified Rankin Scale (mRS) 0–2) and mortality. According to receiver operating characteristic (ROC) analysis, the optimal cut-off was determined by maximizing the Youden index to evaluate the prognostic value of CIV.

Results Of the 110 MRI-selected patients with ABAO, 64 (58.18%) had a cerebellar infarct. The median CIV was 9.6 mL (IQR 2.7–31.4). Successful reperfusion was achieved in 81.8% of the cases. At 90 days the proportion of patients with mRS ≤2 was 31.8% and the overall mortality rate was 40.9%. Baseline CIV was significantly associated with 90-day mRS 0–2 (p=0.008) in the univariate analysis and was an independent predictor of 90-day mortality (adjusted OR 1.79, 95% CI 1.25 to 2.54, p=0.001). The ROC analysis showed that a CIV ≥4.7 mL at the initial MRI was the optimal cut-off to discriminate patients with a higher risk of death at 90 days (area under the ROC curve (AUC)=0.74, 95% CI 0.61 to 0.87, sensitivity and specificity of 87.9% and 58.1%, respectively).

Conclusions In our series of MRI-selected patients with ABAO, pre-EVT CIV was an independent predictor of 90-day mortality. The risk of death was increased for baseline CIV ≥4.7 mL.

  • MRI
  • posterior fossa
  • stroke
  • thrombectomy
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Footnotes

  • Contributors IM, MM, CD, JL, ELB, and FC participated in the conception and design of the study, analyzed and interpreted the data and were responsible for drafting of the article. JL wrote the statistical analysis plan and was responsible for statistical expertise. IM, MM, CD, FP, CA, ID, NG, GBF, PHL, YB, GG, LC, VC, ELB, and FC were responsible for the provision of study materials or patients and provided feedback on the paper. IM, MM, CD, FP, ELB, and FC were responsible for collection, assembly, and possession of the raw data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the local ethics committee, the Institutional Review Board (IRB) of the University Hospital of Montpellier, (IRB-MTP_2020_10_202000630). It was carried out in accordance with the 1964 Helsinki Declaration and its later amendments. Clinical Trials.gov ID: NC T04611178.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available from the corresponding author on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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