Rapid Successful Reperfusion of Basilar Artery Occlusion Strokes With Pretreatment Diffusion‐Weighted Imaging Posterior‐Circulation ASPECTS <8 Is Associated With Good Outcome

Abstract

Background The association between time to reperfusion and clinical outcome is well known in anterior circulation strokes, whereas the impact of main time metrics remains unknown in posterior circulation strokes. We investigated the clinical effect of different time intervals from symptom onset to reperfusion on the 90‐day clinical outcome in acute ischemic stroke patients with basilar artery occlusion, and especially in the subset population presenting a low stroke volume on baseline diffusion‐weighted imaging. Methods and Results We studied patients included in the prospective, multicenter, observational ETIS (Endovascular Treatment in Ischemic Stroke) registry who had had basal artery occlusion and had achieved successful reperfusion (modified Thrombolysis In Cerebral Infarction 2b‐3). Three time intervals (onset to reperfusion, onset to imaging, and imaging to reperfusion) were considered in all patients and separately in patients with pc‐ ASPECTS (posterior‐circulation Alberta Stroke Program Early Computed Tomography Score) <8 and ≥8 on baseline diffusion‐weighted imaging. The primary end point was good outcome defined as 90‐day modified Rankin Scale scores of 0 to 2. Among the 95 included patients, 38 (40%) achieved a good outcome. In all patients, no significant association was found between the different time intervals and outcome. In patients evaluated with diffusion‐weighted imaging (n=61) at baseline, a significant negative association was found between imaging‐to‐reperfusion time for patients with pc‐ ASPECTS <8 (adjusted odds ratio=0.4 per 30‐minute increase; 95% CI 0.18‐0.85; P =0.02) compared with those with pc‐ ASPECTS ≥8. Conclusions In patients with basilar artery occlusion and pc‐ ASPECTS <8 at baseline diffusion‐weighted imaging, clinical outcome is highly dependent on the time from imaging to reperfusion, which suggests that rapid endovascular reperfusion should be performed after imaging in these patients.

Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study

“…In our study, pc-ASPECTS was associated with functional outcome. Few studies examined DWI data and functional outcome in posterior circulation strokes [15, 21, 22, 23]. Tei et al [15] assessed pc-ASPECTS on DWI according to the method described by Puetz et al [16] and showed that, in 132 patients with AIS in the posterior circulation, pc-ASPECTS is an independent predictor of favorable outcome (mRS 0–2) [15].…”

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

“…23,24 In contrast, other factor, such as recanalization of the basilar artery, was not closely associated with the clinical outcome in our study, which was different from the previous studies. 25–27 The reason for this might be the small sample size of failed recanalization ( n = 15) in our study. Also, the results about the BAO site differed from the previous studies.…”

Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

“…Newer devices with large-bore catheters may shorten the recanalization time and improve mortality rates as seen in our patients; however, the selection of patients who have a high likelihood of achieving a good outcome is another essential factor. Imaging-based identification of the initial extent of the core may be helpful in selecting patients who will benefit from mechanical thrombectomy [ 21 ].…”