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Prognostic value of pretreatment diffusion-weighted imaging score for acute basilar artery occlusion with successful endovascular recanalization

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

The aim of this study is to test the prognostic value of a diffusion-weighted imaging (DWI) score in acute basilar artery occlusion (ABAO) with successful recanalization.

Methods

The DWI-based pons-midbrain and thalamus (PMT) score was developed to assess posterior circulation infarcts. We test its prognostic value and compare it with other two established scales, the DWI-based posterior circulation acute stroke prognosis Early CT score (PC-ASPECTS) and brain stem score (BSS). A retrospective cohort of consecutive ABAO patients with pretreatment magnetic resonance imaging and successful recanalization (defined as modified Thrombolysis in Cerebral Infarction 2b-3) were analyzed. A favorable outcome was defined as a 90-day modified Rankin Scale (mRS) score of 2 or less. The prognostic performance of three scales was estimated by receiver operating characteristic (ROC) curve analyses.

Results

One hundred and sixteen eligible patients (mean age, 59.1 ± 11.7 [standard deviation]; 96 [82.8%] man) were included and evaluated. Between favorable (mRS ≤ 2) and unfavorable groups, the baseline PMT score (median [interquartile range], 3 [1–4] versus 6 [5–8]; P < 0.001) differs significantly. ROC curve analyses showed the PMT score had the best prognostic value for favorable outcome (area under the curve, PMT versus BSS versus PC-ASPECTS = 0.80 versus 0.72 versus 0.68, P = 0.010). Multivariate logistic regression analyses showed baseline National Institute of Health stroke scale (OR, 0.90 [95%CI, 0.86–0.95], P = 0.004) and PMT score < 5 (OR, 17.83 [95%CI, 3.91–81.19], P < 0.001) were independent prognostic factors of favorable outcome.

Conclusions

The PMT score seems to predict clinical outcome of ABAO patients with successful recanalization.

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Abbreviations

PMT score:

The pons-midbrain and thalamus score

ABAO:

Acute basilar artery occlusion

EVT:

Endovascular treatment

DWI:

Diffusion-weighted imaging

PC-ASPECTS:

Posterior circulation acute stroke prognosis early CT score

BSS:

Brain stem score

BEST:

Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment

BASICS:

Basilar Artery International Cooperation Study

NIHSS:

National Institute of Health stroke scale

mRS:

Modified Rankin scale

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Funding

Supported by the Beijing Municipal Hospital Scientific Research and Cultivation Program (PX2022020).

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Lian Liu, Zequan Yu & Zhongrong Miao

  2. Department of Intensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China

    Meiping Wang

  3. Image Processing Center, Beihang University, Beijing, 102206, China

    Yuanyuan Wang

Authors
  1. Lian Liu
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  2. Meiping Wang
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  3. Yuanyuan Wang
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  4. Zequan Yu
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Corresponding author

Correspondence to Lian Liu.

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Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

This study was reviewed and approved by the institutional review board of Beijing Tiantan Hospital. Informed consent was waived because of the retrospective nature of the study.

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The data are anonymous and therefore the requirement for informed consent was waived by our local ethics committee.

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Liu, L., Wang, M., Wang, Y. et al. Prognostic value of pretreatment diffusion-weighted imaging score for acute basilar artery occlusion with successful endovascular recanalization. Neuroradiology 65, 619–627 (2023). https://doi.org/10.1007/s00234-022-03090-w

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