Neuroimaging Predictors of Clinical Outcome in Acute Basilar Artery Occlusion

Garg, Ravi; Biller, José

doi:10.3389/fneur.2017.00293

Cited by 12 publications

(13 citation statements)

References 28 publications

(31 reference statements)

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“…Although on the PMI requires CT for evaluation, the post-interventional PMI was highly predictive of mortality, as suggested by the multifactor analysis in our study. This trend is in line with other findings reported in the literature (20,36).…”

Section: Discussionsupporting

confidence: 94%

“…The baseline posterior circulation Acute Stroke Prognosis Early CT Score (Pc-ASPECTS) ( 19 ) and pons-midbrain index (PMI) ( 20 ) both at admission and within 24 h after surgery were evaluated based on preoperative and postoperative neuroimaging and CTA source images. The location of BA occlusion was also classified as proximal (from the vertebrobasilar junction to the origin of the anterior inferior cerebellar artery), middle (from the origin of the anterior inferior cerebellar artery to the origin of the superior cerebellar artery), or distal (distal to the origin of the superior cerebellar artery) according to previously published criteria ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

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Predictors of Functional Outcome and Mortality in Endovascular Treatment for Acute Basilar Artery Occlusion: A Single-Centre Experience

Cao

Chen

et al. 2021

Front. Neurol.

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Background and Purpose: The objective of this study was to identify prognostic factors of endovascular treatment in patients with acute basilar artery occlusion and add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion.Materials and Methods: We reviewed the data of 101 patients with acute basilar artery occlusion receiving endovascular treatment from January 2013 to September 2019. Baseline characteristics and outcomes were evaluated. A favourable functional outcome was defined as a mRS of 0 to 2 assessed at the 3 month follow-up. The association of clinical and procedural characteristics with the functional outcome and mortality was assessed.Results: The study population consisted of 101 patients: 83 males and 18 females. Successful recanalization was achieved in 99 patients (97.1%). A favourable clinical outcome was observed in 50 patients (49.5%), and the overall mortality rate was 26.7%. A favourable outcome was significantly associated with NIHSS score at admission and lung infection. Mortality was associated with NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, and diabetes mellitus.Conclusions: This study suggested that NIHSS score at admission, the number of thrombectomy device passes, the postoperative pons-midbrain index, diabetes mellitus, and lung infection can predict the functional outcome and mortality. These initial results add evidence about the efficacy and safety of endovascular treatment for acute basilar artery occlusion and need to be confirmed by further prospective studies.

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Section: Discussionsupporting

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Predictors of Functional Outcome and Mortality in Endovascular Treatment for Acute Basilar Artery Occlusion: A Single-Centre Experience

Cao

Chen

et al. 2021

Front. Neurol.

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“…Currently, we did not aim to investigate HAS as a surrogate for arterial obstruction by thrombus compared to CT angiography but the effect of different image reconstructions on the accuracy of reporting HAS which was not crucially influenced by a possible incorrect assignment of scan data to the group with or without HAS. Second, since HAS is known to be a predictor for vessel occlusion also in another area, such as internal carotid artery, basilar artery, and anterior or posterior cerebral artery [11, 12], it would have been interesting to investigate the effect of the 3 different image reconstructions to HAS not only in middle cerebral artery. In the present study, this restriction was caused by focusing on the novel aspect of less experienced observers in one vessel area.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Thin Slices and Maximum Intensity Projection Reconstructions Increase Sensitivity to Hyperdense Middle Cerebral Artery Sign in Acute Ischemic Stroke

et al. 2020

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Introduction: Cranial nonenhanced CT (NECT) imaging in hyperacute ischemic stroke is rarely used for assessing arterial obstruction of middle cerebral artery by identifying hyperdense artery sign (HAS). Considering, however, its growing importance due to its impact on the decision-making process of thrombolysis with or without mechanical thrombectomy improved sensitivity to HAS is necessary, particularly in the group of less experienced clinicians being frequently the first one assessing the presence of HAS on NECT. Objective: The present study aimed to investigate the effect of different NECT image reconstructions on the correct detection of hyperdense middle cerebral artery sign in a cohort of observers with lower experience level on NECT. Particularly, MIP image reconstructions were expected to be useful for less experienced observers due to both strengthening of the hyperdensity of HAS and streamlining to less image slices. Methods: Twenty-five of 100 patients’ NECT image data presented with HAS. Sixteen observers with lower practice level on NECT (10 radiologists and 6 neurologists) evaluated independently the 3 image reconstructions of each data set with thin slice 1.5 mm, thick slab 5 mm, and 6-mm maximum intensity projection (MIP) and rated the presence of HAS in middle cerebral artery. A GEE model with random observer effect was used to examine the influence of the 3 image reconstructions on sensitivity to HAS. A linear mixed effects regression model was used to investigate the ranking of detectability of HAS. Interrater reliability was determined by Fleiss’ kappa coefficient (κ). Results: Recognition of HAS and sensitivity to HAS significantly differed between the 3 image reconstructions (p = 0.0106). MIP and thin slice reconstructions yielded each on average the highest sensitivities with 73% compared to thick slab reconstruction with 45% sensitivity. The interobserver reliability was fair (κ, 0.3–0.4). Detectability of HAS was significantly easier and better visible ranked on MIP and thin slice reconstructions compared to thick slab (p < 0.05). Conclusion: MIP and thin slice reconstructions increased the sensitivity to HAS (73%), whereas thick slab reconstructions seemed to be less appropriate (45%).

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“…According to Garg and Biller, 12 there were a total of five scoring systems predicting the clinical outcome of acute BAO patients based on the diffusion weighted MRI. Here, we applied three previously published scoring systems to assess the predictive value of them and concluded that compared with DWI Brainstem score and DWI pc-ASPECTS, DWI Renard score could better predict the prognosis, which was independently associated with the clinical outcome of acute BAO patients after endovascular therapy.…”

Section: Discussionmentioning

confidence: 99%

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

Wan

Jin

et al. 2020

Interv Neuroradiol

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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.

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Neuroimaging Predictors of Clinical Outcome in Acute Basilar Artery Occlusion

Cited by 12 publications

References 28 publications

Predictors of Functional Outcome and Mortality in Endovascular Treatment for Acute Basilar Artery Occlusion: A Single-Centre Experience

Predictors of Functional Outcome and Mortality in Endovascular Treatment for Acute Basilar Artery Occlusion: A Single-Centre Experience

Thin Slices and Maximum Intensity Projection Reconstructions Increase Sensitivity to Hyperdense Middle Cerebral Artery Sign in Acute Ischemic Stroke

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

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