Sage Journals: Discover world-class research

Abstract

Background and purpose

The prognosis of patients with acute basilar arterial occlusion after endovascular reperfusion therapy with diffusion-weighted imaging – posterior circulation–Alberta Stroke Program Early Computed Tomography Score (DWI-pc-ASPECTS) of 6 or less remains unclear. We aimed to assess the characteristics and prognosis of endovascular reperfusion therapy in patients with acute basilar arterial occlusion and DWI-pc-ASPECTS of 6 or less.

Methods

We analysed data collected from 1 January 2012 to 31 January 2018 in a prospective neuro-interventional registry of consecutive patients treated with endovascular reperfusion therapy. Clinical and imaging data on patients with DWI-pc-ASPECTS of 6 or less who underwent endovascular reperfusion therapy for acute basilar arterial occlusion were collected for this study. A good clinical outcome was defined as a modified Rankin scale of 2 or less at 90 days.

Results

Forty-five acute basilar arterial occlusion patients with DWI-pc-ASPECTS of 6 or less were included. Among them, 11 (24.4%) patients had a good clinical outcome at 90 days. Patients with a good clinical outcome had less severe neurological symptoms at presentation (National Institutes of Health Stroke Scale (NIHSS) 19.0 (12.0–25.0) vs. 8.0 (6.0–11.5); P = 0.003) and were younger (72.5 years (57.0–80.0 years) vs. 63.0 years (55.5–69.0 years), P = 0.096) than those with a poor clinical outcome. The symptomatic intracranial haemorrhage rate was significantly higher in the poor clinical outcome group (13 (38.2%)) than in the good clinical outcome group (0 (0.0%)) (P = 0.045). In particular, in patients aged over 70 years, a favourable outcome was low (18 (52.9%) vs. 1 (9.1%); P = 0.027) even after successful recanalisation. In a multivariate model, a low initial NIHSS score (odds ratio 1.21; 95% confidence interval 1.07–1.44; P = 0.0093) and age over 70 years (odds ratio 15.27; 95% confidence interval 1.85–379.79; P = 0.0321) were independent predictors of poor clinical outcome.

Conclusions

Even with DWI-pc-ASPECTS of 6 or less, good clinical outcome can be achieved after endovascular reperfusion therapy. Relatively mild initial symptoms and younger age can predict a better outcome in acute basilar arterial occlusion patients with DWI-pc-ASPECTS of 6 or less.

Keywords

Basilar artery diffusion magnetic resonance imaging mechanical thrombolysis stroke thrombectomy

Get full access to this article

View all access options for this article.

References

Berkhemer

Fransen

PSS

Beumer

et al.

A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20.

Campbell

BCV

Mitchell

Kleinig

et al.

Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018.

Goyal

Demchuk

Menon

et al.

Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030.

Saver

Goyal

Bonafe

et al.

Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295.

Lindsberg

Pekkola

Strbian

et al.

Time window for recanalization in basilar artery occlusion. Speculative Synthesis 2015; 85: 1806–1815.

Lindsberg

Sairanen

Nagel

et al.

Recanalization treatments in basilar artery occlusion – systematic analysis. Eur Stroke J 2016; 1: 41–50.

Mattle

Arnold

Lindsberg

et al.

Basilar artery occlusion. Lancet Neurol 2011; 10: 1002–1014.

Kumar

Shahripour

Alexandrov

. Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis. J Neurointervent Surg 2015; 7: 868–874.

Singer

Berkefeld

Nolte

et al.

Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 2015; 77: 415–424.

10.

Barber

Hill

Eliasziw

et al.

Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol, Neurosurg Psychiatry 2005; 76: 1528–1533.

11.

Schröder

Thomalla

. A critical review of Alberta stroke program early CT score for evaluation of acute stroke imaging. Front Neurol 2016; 7: 245.

12.

Jung

Bae

et al.

A comparison between mechanical thrombectomy and intra-arterial fibrinolysis in acute basilar artery occlusion: single center experiences. J Stroke 2016; 18: 211–219.

13.

Yoon

Kim

Heo

et al.

Predictors of good outcome after stent-retriever thrombectomy in acute basilar artery occlusion. Stroke 2015; 46: 2972–2975.

14.

Luo

Tong

et al.

Factors associated with 90-day outcomes of patients with acute posterior circulation stroke treated by mechanical thrombectomy. World Neurosurg 2018; 109: e318–e328.

15.

Tei

Uchiyama

Usui

et al.

Diffusion-weighted ASPECTS as an independent marker for predicting functional outcome. J Neurol 2011; 258: 559–565.

16.

Manceau

Soize

Gawlitza

et al.

Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI-ASPECTS < /=5)?. Eur J Neurol 2018; 25: 105–110.

17.

Ohta

Morimoto

Okada

et al.

Mechanical thrombectomy in anterior circulation occlusion could be more effective than medical management even in low DWI-ASPECTS patients. Neurol Medico-Chirurg 2018; 58: 156–163.

18.

Desilles

Consoli

Redjem

et al.

Successful reperfusion with mechanical thrombectomy is associated with reduced disability and mortality in patients with pretreatment diffusion-weighted imaging–Alberta stroke program early computed tomography score </=6. Stroke 2017; 48: 963–969.

19.

Lee

Suh

Cho

et al.

Subacute endovascular recanalization of symptomatic cerebral artery occlusion: a propensity score-matched analysis. J Neurointervent Surg 2018; 10: 536–542.

20.

Archer

Horenstein

. Basilar artery occlusion: clinical and radiological correlation. Stroke 1977; 8: 383–390.

21.

Castonguay

Zaidat

Novakovic

et al.

Influence of age on clinical and revascularization outcomes in the North American Solitaire Stent-Retriever Acute Stroke Registry. Stroke 2014; 45: 3631–3636.

22.

Zaidat

Yoo

Khatri

et al.

Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 2013; 44: 2650–2663.

23.

Huo

Gao

Sun

et al.

Endovascular mechanical thrombectomy with the Solitaire device for the treatment of acute basilar artery occlusion. World Neurosurg 2016; 89: 301–308.

24.

Baek

Yoon

Kim

et al.

Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset. AJNR Am J Neuroradiol 2014; 35: 989–993.

25.

Rajamand

Mehra

et al.

Outcome of mechanical thrombectomy in the very elderly for the treatment of acute ischemic stroke: the real world experience. Acta Radiol Open 2015; 4(9): DOI: 10.1177/2058460115599423.

26.

Raoult

Eugene

Ferre

et al.

Prognostic factors for outcomes after mechanical thrombectomy with solitaire stent. J Neuroradiol J Neuroradiol 2013; 40: 252–259.

27.

Brisson

Hsieh

Y-T

Kim

et al.

Brainstem neurons survive the identical ischemic stress that kills higher neurons: insight to the persistent vegetative state. PLoS ONE 2014; 9: e96585.

28.

Albers

. Late window paradox. Stroke 2018; 49: 768–771.

29.

Nogueira

Jadhav

Haussen

et al.

Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378: 11–21.

30.

Albers

Marks

Kemp

et al.

Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378: 708–718.

31.

Bentsen

Christensen

et al.

Outcome and risk factors presented in old patients above 80 years of age versus younger patients after ischemic stroke. J Stroke Cerebrovasc Dis: the official journal of the National Stroke Association 2014; 23: 1944–1948.

32.

Koyanagi

Yoshida

Kurosaki

et al.

Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during carotid artery stenting. J Neurointervent Surg 2016; 8: 576–580.

33.

Schonewille

Algra

Serena

et al.

Outcome in patients with basilar artery occlusion treated conventionally. J Neurol, Neurosurg Psychiatry 2005; 76: 1238–1241.

34.

Mourand

Machi

Nogué

et al.

Diffusion-weighted imaging score of the brain stem: a predictor of outcome in acute basilar artery occlusion treated with the Solitaire FR device. Am J Neuroradiol 2014; 35: 1117–1123.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.13 MB

DWI-pc-ASPECT score in basilar artery occlusion: is 6 points or less always indicative of a bad outcome?

Abstract

Background and purpose

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material