Diffusion-Weighted Imaging Score of the Brain Stem: A Predictor of Outcome in Acute Basilar Artery Occlusion Treated with the Solitaire FR Device

Mourand, Isabelle; Machi, Paolo; Nogué, Erika; Arquizan, Caroline; Costalat, Vincent; Picot, Marie‐Christine; Bonafé, Alain; Milhaud, D.

doi:10.3174/ajnr.a3870

Cited by 48 publications

(37 citation statements)

References 22 publications

(41 reference statements)

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“…The previously identified factors independently associated with a good outcome after endovascular therapy in posterior circulation stroke included a low baseline NIHSS, successful reperfusion, a history of smoking, a high DWI‐Acute Stroke Program Early CT Score (ASPECTS), a shorter time to the start of procedure, a shorter time to reperfusion, better collateral status, and magnetic resonance imaging–based patient selection 3, 7, 9, 18, 19. Recently, Gory et al reported that only the failure to achieve successful reperfusion was an independent predictor of mortality at 3 months, in patients with acute BAO who underwent thrombectomy 20.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

121

117

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BackgroundDespite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO.Methods and ResultsThis study included 212 consecutive patients with acute BAO who underwent either stent‐retriever or contact aspiration thrombectomy as the first‐line approach between January 2011 and August 2017 at 3 stroke centers. Clinical and radiologic data were prospectively collected and stored in a database at each center. Multivariable ordinal logistic regression was performed to assess the association between each characteristic and 90‐day modified Rankin scale scores. Reperfusion was successful in 91.5% (194/212) of patients; 44.8% (95/212) of patients achieved 90‐day modified Rankin scale 0 to 2. The symptomatic hemorrhage rate was 1.9% (4/212) and mortality was 16% (34/212). In a multivariable ordinal regression, younger age, lower National Institute of Health stroke scale on admission, and absence of diabetes mellitus and parenchymal hematoma were significantly associated with a favorable shift in the overall distribution of 90‐day modified Rankin scale scores. Treatment outcomes were similar between patients who received stent‐retriever thrombectomy and contact aspiration thrombectomy as the first‐line technique.ConclusionsEndovascular thrombectomy was effective and safe for treating patients with acute BAO. Age, the baseline National Institute of Health stroke scale, diabetes mellitus, and parenchymal hematoma were associated with better outcomes. This study showed no superiority of the stent‐retriever over the aspiration thrombectomy for treating acute BAO.

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Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Kang

Jung

Yoon

et al. 2018

JAHA

121

117

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“…In contrast, in the study by Karameshev et al, 14 the DWI pc-ASPECTS was not significantly associated with outcome after adjusting for NIHSS, Glasgow Coma Scale, and other DWI scoring systems. Mourand et al 11 also reported that a DWI pc-ASPECTS of ≥7 was not statistically relevant for predicting good outcome in a univariate logistic regression analysis. These discrepancies might be because of differences among studies in patient selection criteria, treatment methods, recanalization results, or the time windows between onset and treatment.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion

Yoon

Kim

Heo

et al. 2015

Stroke

104

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Background and Purpose— Factors related to prognosis after a modern mechanical thrombectomy in patients with acute basilar artery occlusion remain unclear. This study investigated the prognostic factors for patients with acute basilar artery occlusion who underwent a stent-retriever thrombectomy. Methods— We analyzed clinical and pretreatment diffusion-weighted imaging (DWI) data in 50 consecutive patients with acute basilar artery occlusion treated with stent-retriever thrombectomy. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and DWI parameters and functional outcome was evaluated with logistic regression analysis. Results— In a univariate analysis, the following variables were significantly associated with outcome: age, hypertension, baseline National Institutes of Health Stroke Scale, posterior circulation Acute Stroke Prognosis Early CT Score on a pretreatment DWI, posterior circulation Acute Stroke Prognosis Early CT Score of ≥7 (versus <7), thalamic infarction, and bilateral thalamic infarction. In a multivariate model, only a low initial National Institutes of Health Stroke Scale score (odds ratio, 0.82; 95% confidence interval, 0.709–0.949; P =0.008) and high DWI posterior circulation Acute Stroke Prognosis Early CT Score (odds ratio, 1.854; 95% confidence interval 1.012–3.397; P =0.045) were significant independent predictors of good outcome. In a univariate analysis, bilateral thalamic infarction was associated with a poor outcome (odds ratio, 1.993; 95% confidence interval, 1.187–3.346; P =0.035) but not with a unilateral thalamic infarction ( P =0.525). Conclusions— This study suggested that initial infarction severity and posterior circulation Acute Stroke Prognosis Early CT Score on a pretreatment DWI are independent predictors of clinical outcome after stent-retriever thrombectomy in patients with acute basilar artery occlusion.

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“…35 Single-centre studies with samples less than 100 patients have shown good functional outcomes following thrombectomy of the basilar artery, ranging from 30% 36,37 to 48%. [38][39][40] Experience at the Karolinska Hospital showed a 57% rate of good functional outcome (95% CI 37% to 75%), and of 73% (95% CI 50% to 89%) when there were no signs of acute infarction prior to treatment, with about 21% mortality. 41 Recanalization rates over 75% were reported with new generation devices 37,42 as well as with older generation devices in the MERCI and multi-MERCI trials but with lower benefit.…”

Section: Aspects To Be Considered In Mechanical Thrombectomymentioning

confidence: 99%

“…60 A smaller study from the same centre on 31 consecutive patients, focusing on basilar artery occlusion treated with Solitaire FR device, found a good correlation between brainstem DWI score <3 and favorable clinical outcome. 40 The prospective, single-arm multicentre DEFUSE-2 trial showed favorable clinical outcomes in patients selected for endovascular treatment with MRI perfusion-weighted imaging (PWI) mismatch in MCA or ICA occlusions (n ¼ 98, about half pre-treated with IVT). 61 Perfusion-CT-based imaging: A multicentre analysis of 165 patients, the vast majority of whom underwent endovascular or intravenous recanalization treatment, showed independent prognostic value of core and penumbra volumes on clinical outcome.…”

Section: 12mentioning

confidence: 99%

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

Wahlgren

Moreira

Michel³

et al. 2015

International Journal of Stroke

327

227

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The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after

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Diffusion-Weighted Imaging Score of the Brain Stem: A Predictor of Outcome in Acute Basilar Artery Occlusion Treated with the Solitaire FR Device

Cited by 48 publications

References 22 publications

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

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