MRI-Based Score for Acute Basilar Artery Thrombosis

Abstract

Background: Intra-arterial thrombolysis may reduce mortality in acute basilar artery (BA) occlusion. We wanted to identify an easy-to-use pre-treatment MR-based predictor of clinical outcome in patients with acute BA occlusion treated with IAT. Methods: We analyzed 16 patients with acute BA occlusion prospectively. Vascular risk factors, as well as National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores were recorded on admission, together with a 10-point semiquantitative score reflecting the number of acute ischaemic brain lesions on diffusion-weighted imaging. The recanalization grade was evaluated by angiography. The clinical outcome, using the modified Rankin scale (mRs), was measured 3 months later. Results: Risk factors, NIHSS and GCS scores, time from symptom onset to treatment, recanalization rate, outcome and outcome predictors (such as age, NIHSS and GCS scores) were comparable to other studies. Haemorrhagic transformation of infarction occurred in 2 patients (12.5%). We found that a high lesion score was an additional predictor of poor outcome (p = 0.026). Conclusions: In patients with acute BA occlusion, treated with intra-arterial recombinant tissue plasminogen activator, a high number of acute ischaemic lesions, based on diffusion-weighted imaging, is a predictor of poor clinical outcome.

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

“…The mean time to assess the DWI BSS was 136 seconds (range, 16 -300 seconds). On the DWI, the median pc-ASPECTS was 6 (IQR ϭ 4 -8; range ϭ 2-10) and the median Renard et al 15 score was 3 (IQR ϭ 2-4.5; range ϭ 0 -6). All patients showed complete occlusion of the basilar artery (TICI 0).…”

“…The DWI BSS was moderately correlated with the score of Renard et al 15 (r ϭ 0.63) and was weakly correlated with the pc-ASPECTS (r ϭ Ϫ0.38), whereas a strong correlation appeared between the pc-ASPECTS and the score of Renard et al (r ϭ Ϫ0.88).…”

“…13,14 More recently, investigators have studied the functional outcome and extent of lesions in patients with a posterior circulation infarction by diffusion-weighted MR imaging. [15][16][17] Because of the high attenuation of the anatomic architecture in the brain stem, lesion location rather than lesion volume can be critical in determining functional outcome after a posterior circulation infarction, especially when the brain stem is involved. 18 The aim of our study was to test the reproducibility and validity of a novel baseline and easy-to-use prethrombectomy DWI brain stem score (BSS) in 31 consecutive patients with proved ABAO and treated within 24 hours of symptom onset, by using mechanical thrombectomy.…”

Technical Feasibility and Application of Mechanical Thrombectomy with the Solitaire FR Revascularization Device in Acute Basilar Artery Occlusion

“…This finding might be attributable to the small sample size of the study. On the other hand, especially in basilar artery occlusions, other factors have been noted as predictors for outcome, such as high initial NIHSS score at presentation, younger age, time span from onset to recanalization, and thrombus extent and location, 3,5,6,[23][24][25][26][27] which may influence clinical outcome in addition to recanalization success. The main causes of acute BAOs are atherothrombotic occlusions, due to local thrombosis on the ground of a high-grade stenosis, and embolic occlusions, due to cardiac or arterio-arterial thromboembolism.…”

“…This low hemorrhage rate compares favorably with the rates of symptomatic intracranial hemorrhage reported in other stentretriever studies (0% to 17%) 10,11,15,16 and with acute BAO treatment (0% to 19%). 8,9,23,24,26,36,37 This study has inherent limitations due to the retrospective design and the small number of patients. Furthermore, the application of a multimodal approach might confound the treatment effect of mechanical thrombectomy.…”