scholarly journals Brain Stem Diffusion-Weighted Imaging Lesion Score: A Potential Marker of Outcome in Acute Basilar Artery Occlusion

2008 ◽  
Vol 30 (1) ◽  
pp. 194-198 ◽  
Author(s):  
T.-H. Cho ◽  
N. Nighoghossian ◽  
F. Tahon ◽  
C. Némoz ◽  
M. Hermier ◽  
...  
Keyword(s):  
Brain Stem ◽  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Lesion Score ◽  
Diffusion Weighted ◽  
Potential Marker

Novel Diffusion-Weighted Imaging Score Showed Good Prognostic Value for Acute Basilar Artery Occlusion Following Endovascular Treatment: The Pons-Midbrain and Thalamus Score

Stroke ◽  
2021 ◽  
Author(s):  
Lian Liu ◽  
Meiping Wang ◽  
Yiming Deng ◽  
Gang Luo ◽  
Xuan Sun ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Brain Stem ◽  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Good Outcome ◽  
Diffusion Weighted

Background and Purpose: Prognostic factors for outcome of endovascular treatment remains to be investigated in patients with acute basilar artery occlusion. We aimed to assess the prognostic value of a novel pretreatment diffusion-weighted imaging score: The Pons-Midbrain and Thalamus (PMT) score. Methods: Eligible patients who underwent endovascular treatment due to acute basilar artery occlusion were reviewed. The PMT score was a diffusion-weighted imaging–based semiquantitative scale in which the infarctions of pons, midbrain, and thalamus were fully considered. The PMT score was assessed as well as the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score and Brain Stem Score. Good outcomes were defined as a modified Rankin Scale score of ≤3 at 90-day and successful reperfusion as Thrombolysis in Cerebral Infarction grades 2b/3. The associations between baseline clinical parameters and good outcomes were evaluated with logistic regression. Results: A total of 107 patients with pretreatment magnetic resonance imaging were included in this cohort. The baseline PMT score (median [interquartile range], 3 [1–5] versus 7 [5–9]; P <0.001) and Brain Stem Score (median [interquartile range], 2 [1–4] versus 3 [2–5]; P =0.001) were significantly lower in good outcome group; the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was higher in good outcome group without statistical significance. As a result of receiver operating characteristic curve analyses, the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score showed poor prognostic accuracy for good outcome (area under the curve, 0.60 [95% CI, 0.49–0.71]; P =0.081); The baseline PMT score showed significantly better prognostic accuracy for 90-day good outcome than the Brain Stem Score and National Institutes of Health Stroke Scale (area under the curve, 0.80 versus 0.68 versus 0.78, P =0.003). In addition, favorable PMT score <7 (odds ratio, 22.0 [95% CI, 6.0–80.8], P <0.001), Brain Stem Score <3 (odds ratio, 4.65 [95% CI, 2.05–10.55], P <0.001) and baseline National Institutes of Health Stroke Scale <23 (odds ratio, 8.0 [95% CI, 2.5–25.6], P <0.001) were associated with improved good outcome. Conclusions: In patients with acute basilar artery occlusion following endovascular treatment, the pretreatment diffusion-weighted imaging based PMT score showed good prognostic value for clinical outcome.

scholarly journals Functional Independence following Endovascular Treatment for Basilar Artery Occlusion despite Extensive Bilateral Pontine Infarcts on Diffusion-Weighted Imaging: Refuting a Self-Fulfilling Prophecy

2016 ◽  
Vol 5 (3-4) ◽  
pp. 179-184 ◽  
Author(s):  
Diogo C. Haussen ◽  
Renato A.C. Oliveira ◽  
Vikas Patel ◽  
Raul G. Nogueira
Keyword(s):  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Treatment Decision ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Decision Algorithm ◽  
Operator Experience ◽  
Diffusion Weighted

Background and Purpose: Extensive brainstem diffusion-weighted imaging (DWI) hyperintensity has been associated with poor outcomes. We aim at documenting a series of patients with extensive DWI pontine lesions who achieved independence following endovascular therapy and aggressive medical therapy in the setting of posterior circulation basilar artery occlusion (BAO). Methods: This is a retrospective endovascular database review of a single-operator experience over a 9-year period for patients with (1) complete BAO, (2) extensive bilateral pontine DWI changes and (3) 90-day modified Rankin scale 0-2. Results: Three out of a total of 40 patients met the inclusion criteria. Case 1 was an 18-year-old male with National Institutes of Health Stroke Scale (NIHSS) 32 on admission, treated 25 h after symptom onset. Case 2 was a 56-year-old male with NIHSS 19, treated 10 h after onset. Case 3 was a 73-year-old male with NIHSS 29, treated 6 h after onset. Full endovascular reperfusion was achieved in all 3 patients. A literature review identified 9 additional cases of extensive pontine DWI changes and good outcome. These patients were young (32 ± 22 years), mostly males (69%), presented with a relatively low posterior circulation Acute Stroke Prognosis Early CT Score (6 ± 1), were treated relatively late from last known normal (13 ± 10 h) and were mostly (84%) treated with endovascular intervention. Conclusion: Extensive bilateral pontine DWI lesions among patients with BAO are not an unequivocal indicator of poor prognosis. We advise strong caution when considering these findings in the treatment decision algorithm.

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

2020 ◽  
pp. 159101992094051
Author(s):  
Can Wan ◽  
Guangliang Wu ◽  
Xing Jin ◽  
Shaojun Liao ◽  
Foming Zhang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Predictive Value ◽  
Odds Ratio ◽  
Diffusion Weighted Imaging ◽  
Area Under The Curve ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Diffusion Weighted

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.

Association of pretreatment pontine infarction with extremely poor outcome after endovascular thrombectomy in acute basilar artery occlusion

2020 ◽  
pp. neurintsurg-2020-015930
Author(s):  
Woong Yoon ◽  
Byung Hyun Baek ◽  
Yun Young Lee ◽  
Seul Kee Kim ◽  
Joon-Tae Kim ◽  
...  
Keyword(s):  
Brain Stem ◽  
Basilar Artery ◽  
Multivariate Logistic Regression Analysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Infarct Core ◽  
Endovascular Thrombectomy ◽  
Poor Outcome ◽  
Pontine Infarction ◽  
Pontine Infarct

BackgroundThe association between pretreatment brain stem infarction and thrombectomy outcomes remains to be elucidated in patients with acute basilar artery occlusion (BAO). We aimed to assess the association between pretreatment pontine infarction and extremely poor outcome in patients who underwent endovascular thrombectomy due to acute BAO.MethodsWe retrospectively reviewed data from a stroke database to identify patients with acute BAO who underwent thrombectomy between January 2011 and August 2019. Patient characteristics, pretreatment diffusion-weighted imaging (DWI) data, and outcomes were evaluated. The largest infarct core was expressed as the percentage of infarct core area in each brain stem region on the DWI slice displaying the largest lesion. Extremely poor outcome was defined as a 90-day modified Rankin Scale score of 5 or 6.ResultsA total of 113 patients were included, 37 of whom had extremely poor outcome. Among the 15 patients with extensive pontine infarction (largest pontine infarct core of ≥70%), 93.3% had extremely poor outcome. Multivariate logistic regression analysis revealed that the following variables were independent predictors of extremely poor outcome: extensive pontine infarction (adjusted OR 22.494; 95% CI 2.335 to 216.689; p=0.007), posterior circulation ASPECTS on DWI (adjusted OR per 1-point decrease 1.744; 95% CI 1.197 to 2.541; p=0.004), age (adjusted OR per 1-year increase 1.067; 95% CI 1.009 to 1.128; p=0.023), and baseline NIHSS (adjusted OR per 1-point increase 1.105; 95% CI 1.004 to 1.216; p=0.040).ConclusionOur results showed that a large pontine infarct core of ≥70% on pretreatment DWI was strongly associated with extremely poor outcome among patients treated with endovascular thrombectomy for acute BAO.

Fusiform Basilar Artery Aneurysm in a 33-Month-Old Child

Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 631-634 ◽  
Author(s):  
John R. Little ◽  
Mark V. Larkins ◽  
Hans LÜders ◽  
Joseph F. Hahn ◽  
Gerald Erenberg
Keyword(s):  
Brain Stem ◽  
Basilar Artery ◽  
Evoked Potential ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Auditory Evoked Potential ◽  
Basilar Artery Occlusion ◽  
Acute Subarachnoid Hemorrhage ◽  
Rare Lesion ◽  
Evoked Potential Monitoring

Abstract A 33-month-old girl presented with acute subarachnoid hemorrhage from a ruptured multilobulated fusiform aneurysm of the midbasilar artery. This rare lesion was treated surgically by occluding the basilar artery. Intraoperative brain stem auditory evoked potential and somatosensory evoked potential monitoring results did not change with basilar artery occlusion, suggesting that the occlusion would be tolerated. However, the amplitudes of brain stem auditory evoked potential Waves III-V to right ear stimulation were transiently reduced during left pontine retraction during the aneurysm exposure. The patient made a complete clinical recovery.

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