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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Supported by the Beijing Municipal Hospital Scientific Research and Cultivation Program (PX2022020).
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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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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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DOI: https://doi.org/10.1007/s00234-022-03090-w