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Wu C, Wang J, Zhang L, Yan F, Yang Z, He L, Guo J. Effect of massive cerebellar infarction on the outcomes of patients with acute basilar artery occlusion during hospitalization after endovascular treatment: A retrospective study. Medicine (Baltimore) 2023; 102:e34154. [PMID: 37478217 PMCID: PMC10662876 DOI: 10.1097/md.0000000000034154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/09/2023] [Indexed: 07/23/2023] Open
Abstract
Acute basilar artery occlusion (ABAO) after endovascular treatment (EVT) is often associated with a poor prognosis, particularly in patients with cerebellar infarction who may develop malignant cerebellar edema. The present study aimed to investigate how massive cerebellar infarction (MCI) affects hospitalization outcomes in ABVO patients who undergo EVT. We conducted a retrospective study of ABVO patients who underwent EVT at our hospital between September 2017 and September 2022. MCI was diagnosed using imaging techniques, and various prognostic scores were assessed during hospitalization to examine the relationship between MCI and these outcomes. We identified 42 ABAO patients, of whom 22 (52.4%) had MCI. Patients with MCI had a higher modified Rankin Scale (mRS) score at discharge compared to those without MCI (4.36 ± 1.14 vs 3.05 ± 1.85, P = .042, odds ratio [OR] (95% confidence interval [CI]) = 1.093 (0.083, 2.103)), and a lower Glasgow Coma Scale score (6.59 ± 4.0 vs 10.10 ± 5.07, P = .036, OR (95% CI) = -3.444 (-6.518, -0.369)). MCI was identified as an independent risk factor for an extremely poor prognosis (mRS ≥ 5) at discharge (P = .036, OR (95% CI) = 15.531 (1.603, 313.026)) and for no improvement in mRS score compared to onset (P = .013, OR (95% CI) = 0.025 (0.001, 0.274)). Additionally, an extremely poor prognosis was independently associated with stent implantation, EVT duration, and body mass index, while mRS score improvement was correlated with EVT duration and pulmonary infection. MCI in ABAO patients is a significant independent risk factor for a poor prognosis at discharge and no improvement in function score compared to onset. Early diagnosis and intervention are necessary to improve outcomes, particularly in high-risk populations.
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Affiliation(s)
- Chuyue Wu
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jing Wang
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Lina Zhang
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Fei Yan
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Zhenjie Yang
- Department of Radiology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Lei He
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Jing Guo
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, P.R. China
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Zhang X, Miao J, Yang J, Liu C, Huang J, Song J, Xie D, Yue C, Kong W, Hu J, Luo W, Liu S, Li F, Zi W. DWI-Based Radiomics Predicts the Functional Outcome of Endovascular Treatment in Acute Basilar Artery Occlusion. AJNR Am J Neuroradiol 2023; 44:536-542. [PMID: 37080720 PMCID: PMC10171394 DOI: 10.3174/ajnr.a7851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/15/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment is a reference treatment for acute basilar artery occlusion (ABAO). However, no established and specific methods are available for the preoperative screening of patients with ABAO suitable for endovascular treatment. This study explores the potential value of DWI-based radiomics in predicting the functional outcomes of endovascular treatment in ABAO. MATERIALS AND METHODS Patients with ABAO treated with endovascular treatment from the BASILAR registry (91 patients in the training cohort) and the hospitals in the Northwest of China (31 patients for the external testing cohort) were included in this study. The Mann-Whitney U test, random forests algorithm, and least absolute shrinkage and selection operator were used to reduce the feature dimension. A machine learning model was developed on the basis of the training cohort to predict the prognosis of endovascular treatment. The performance of the model was evaluated on the independent external testing cohort. RESULTS A subset of radiomics features (n = 6) was used to predict the functional outcomes in patients with ABAO. The areas under the receiver operating characteristic curve of the radiomics model were 0.870 and 0.781 in the training cohort and testing cohort, respectively. The accuracy of the radiomics model was 77.4%, with a sensitivity of 78.9%, specificity of 75%, positive predictive value of 83.3%, and negative predictive value of 69.2% in the testing cohort. CONCLUSIONS DWI-based radiomics can predict the prognosis of endovascular treatment in patients with ABAO, hence allowing a potentially better selection of patients who are most likely to benefit from this treatment.
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Affiliation(s)
- X Zhang
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology (X.Z.), The Affiliated Hospital of Northwest University Xi'an No.3 Hospital, Xian, China
| | - J Miao
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology (J.M.), Xianyang Hospital of Yan'an University, Xianyang, China
| | - J Yang
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - C Liu
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - J Huang
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - J Song
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - D Xie
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - C Yue
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - W Kong
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - J Hu
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - W Luo
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - S Liu
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - F Li
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - W Zi
- From the Department of Neurology (X.Z., J.M., J.Y., C.L., J.H., J.S., D.X., C.Y., W.K., J.H., W.L., S.L., F.L., W.Z.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Abdelrady M, Ognard J, Cagnazzo F, Derraz I, Lefevre PH, Riquelme C, Gascou G, Arquizan C, Dargazanli C, Cheddad El Aouni M, Ben Salem D, Mourand I, Costalat V, Gentric JC. Frontline thrombectomy strategy and outcome in acute basilar artery occlusion. J Neurointerv Surg 2023; 15:27-33. [PMID: 34992148 DOI: 10.1136/neurintsurg-2021-018180] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Novel thrombectomy strategies emanate expeditiously day-by-day counting on access system, clot retriever device, proximity to and integration with the thrombus, and microcatheter disengagement. Nonetheless, the relationship between native thrombectomy strategies and revascularization success remains to be evaluated in basilar artery occlusion (BAO). PURPOSE To compare the safety and efficacy profile of key frontline thrombectomy strategies in BAO. METHODS Retrospective analyses of prospectively maintained stroke registries at two comprehensive stroke centers were performed between January 2015 and December 2019. Patients with BAO selected after MR imaging were categorized into three groups based on the frontline thrombectomy strategy (contact aspiration (CA), stent retriever (SR), or combined (SR+CA)). Patients who experienced failure of clot retrieval followed by an interchanging strategy were categorized as a fourth (switch) group. Clinicoradiological features and procedural variables were compared. The primary outcome measure was the rate of complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c-3). Favorable outcome was defined as a 90 day modified Rankin Scale score of 0-2. RESULTS Of 1823 patients, we included 128 (33 underwent CA, 35 SR, 35 SR +CA, and 25 switch techniques). Complete revascularization was achieved in 83/140 (59%) primarily analyzed patients. SR +CA was associated with higher odds of complete revascularization (adjusted OR 3.04, 95% CI 1.077 to 8.593, p=0.04) which was an independent predictor of favorable outcome (adjusted OR 2.73. 95% CI 1.152 to 6.458, p=0.02). No significant differences were observed for symptomatic intracranial hemorrhage, functional outcome, or mortality rate. CONCLUSION Among BAO patients, the combined technique effectively contributed to complete revascularization that showed a 90 day favorable outcome with an equivalent complication rate after thrombectomy.
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Affiliation(s)
- Mohamed Abdelrady
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France .,Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Julien Ognard
- Interventional Neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Federico Cagnazzo
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Imad Derraz
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Pierre-Henri Lefevre
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Carlos Riquelme
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Gregory Gascou
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Caroline Arquizan
- Neurology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Cyril Dargazanli
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | | | - Douraied Ben Salem
- Diagnostic neuroradiology, Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - Isabelle Mourand
- Neurology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
| | - Vincent Costalat
- Interventional Neuroradiology, Hôpital Gui de Chauliac; Pôle Neurosciences tête et cou, Montpellier, Languedoc-Roussillon Midi, France
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Liu C, Li F, Liu S, Chen Q, Sang H, Yang Q, Zhou K, Zi W. Neutrophil Count Predicts Malignant Cerebellar Edema and Poor Outcome in Acute Basilar Artery Occlusion Receiving Endovascular Treatment: A Nationwide Registry-Based Study. Front Immunol 2022; 13:835915. [PMID: 35592334 PMCID: PMC9111017 DOI: 10.3389/fimmu.2022.835915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Acute basilar artery occlusion (ABAO) is known to have a poor outcome with a high rate of morbidity and mortality despite endovascular treatment (EVT), highlighting the necessities of exploring factors to limit the efficacy of EVT in these patients. Cerebellar infarctions in ABAO might progress to malignant cerebellar edema (MCE), a life-threatening complication after reperfusion, posing a secondary injury to the brainstem by mass effects. Therefore, the present research aimed to explore the impacts of MCE on a long-term outcome and investigate the prognostic factors for MCE among ABAO after EVT. Methods In the national BASILAR registry, a total of 329 ABO patients with cerebellar infarctions treated by EVT met the inclusion criteria. The presence of MCE defined by the Jauss scale ≥4 points, was evaluated on the computed tomography performed 72 h after EVT. The adjusted odds ratio and 95% CI were obtained by logistic regression models. A favorable outcome was defined as a 90-day modified Rankin Scale score of 0-3. Results MCE was statistically associated with the decreased incidence of a favorable outcome [adjusted odds ratio, 0.35(95% CI, 0.18-0.68), P=0.002]. The baseline National Institutes of Health Stroke Scale score, collateral circulation, neutrophil count at admission, and recanalization status were predictors for MCE and a favorable functional status at 90 days (all P<0.05). Among all inflammatory factors, the neutrophil count achieved the highest accuracy, sensitivity, and specificity for MCE. Adding the neutrophil count status into the baseline model obviously enhanced its prediction ability for MCE and favorable outcome by increasing the area under curve and achieving both net reclassification and integrated discrimination improvement (all P<0.05). Mediation analysis indicated that MCE mediated the association between the increased neutrophil count and worse functional outcome (P=0.026). Discussion MCE acted essential roles in worsening prognosis for ABAO after EVT. A high neutrophil count at admission was linked to MCE and a poor outcome among ABAO patients, which could be further incorporated into the clinical decision-making system and guide immunomodulation therapy.
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Affiliation(s)
- Chang Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qiong Chen
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kai Zhou
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenji Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Pellegrino MP, Guerra FBD, Perissinotti IN. Decision-making strategies for reperfusion therapies: navigating through stroke trials gaps. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:60-71. [PMID: 35976313 PMCID: PMC9491414 DOI: 10.1590/0004-282x-anp-2022-s123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.
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Affiliation(s)
- Mateus Paquesse Pellegrino
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo, SP, Brazil
| | | | - Iago Navas Perissinotti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto Central, Departamento de Neurologia, São Paulo, SP, Brazil
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Zhao Y, Zhao W, Guo Y, Li Y. Endovascular thrombectomy versus standard medical treatment for stroke patients with acute basilar artery occlusion: a systematic review and meta-analysis. J Neurointerv Surg 2022; 14:1173-1179. [PMID: 35387858 DOI: 10.1136/neurintsurg-2022-018680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Whether endovascular thrombectomy (EVT) is superior to standard medical treatment (SMT) for stroke patients with acute basilar artery occlusion (BAO) is uncertain. This systematic review and meta-analysis aimed to compare the safety and efficacy of EVT with SMT for treating BAO patients. METHODS Papers were retrieved from PubMed, Embase, and the Cochrane Library databases. The primary outcome of this meta-analysis was favorable functional outcomes at 3 months (defined as a modified Rankin Scale (mRS) score of ≤3). A random effect model was used to calculate risk ratios (RR) with 95% confidence intervals (CIs) per outcome. RESULTS Five articles, including two randomized controlled trials (RCTs) and four observational cohort studies, comprising 1484 patients (1024 in the EVT group and 460 in the SMT group), were included in the meta-analysis. The pooled results demonstrated no significant differences between the EVT and SMT groups in achieving favorable functional outcomes at 3 months (RR=1.63, 95% CI 0.90, 2.96; p=0.11). However, patients in the EVT group had higher rates for symptomatic intracerebral hemorrhage (RR=6.22, 95% CI 2.06 to 18.76; p=0.001) but lower mortality at 3 months (RR=0.72, 95% CI 0.56 to 0.91; p=0.007) than patients in the SMT group. CONCLUSION Among patients with BAO, EVT and SMT did not differ significantly in achieving favorable functional outcomes at 3 months, but BAO patients treated with EVT might have lower mortality at 3 months. RCTs are warranted to further assess the efficacy and safety of EVT for BAO patients.
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Affiliation(s)
- Yongli Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Wendong Zhao
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Yingchang Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Yanru Li
- Department of Neurosurgery Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Mourand I, Mahmoudi M, Lebars E, Pavillard F, Dargazanli C, Labreuche J, Gaillard N, Ter Schiphorst A, Derraz I, Sablot D, Corti L, Costalat V, Arquizan C, Cagnazzo F. Predictive value of DWI posterior-circulation lesion volume for 90-day clinical outcome after endovascular treatment of acute basilar artery occlusion: a retrospective single-center study. Neuroradiology 2021; 64:1231-1238. [PMID: 34825967 DOI: 10.1007/s00234-021-02849-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The relationship between posterior-circulation lesion volume (PCLV) and clinical outcomes is poorly investigated. We aimed to analyze, in patients with acute basilar artery occlusion (ABAO), if pre-endovascular treatment (EVT) PCLV was a predictor of outcomes. METHODS We analyzed consecutive MRI selected, endovascularly treated ABAO patients. Baseline PCLV was measured in milliliters on apparent diffusion-coefficient map reconstruction. Univariable and multivariable logistic models were used to test if PCLV was a predictor of 90-day outcomes. After the received operating characteristic (ROC) analysis, the optimal cut-off was determined to evaluate the prognostic value of PCLV. RESULTS A total of 110 ABAO patients were included. The median PCLV was 4.4 ml (interquartile range, 1.3-21.2 ml). Successful reperfusion was achieved in 81.8% of cases after EVT. At 90 days, 31.8% of patients had a modified Rankin scale ≤ 2, and the mortality rate was 40.9%. PCLV was an independent predictor of functional independence and mortality (odds ratio [OR]:0.57, 95% confidence interval [CI], 0.34-0.93 and 1.84, 95% CI, 1.23-2.76, respectively). The ROC analysis showed that a baseline PCLV ≤ 8.7 ml was the optimal cut-off to predict the 90-day functional independence (area under the curve [AUC] = 0.68, 95% CI, 0.57-0.79, sensitivity 88.6%, and specificity 49.3%). In addition, a PCLV ≥ 9.1 ml was the optimal cut-off for the prediction of 90-day mortality (AUC = 0.71, 95% CI, 0.61-0.82, sensitivity 80%, and specificity 60%). CONCLUSIONS Pre-treatment PCLV was an independent predictor of 90-day outcomes in ABAO. A PCLV ≤ 8.7 and ≥ 9.1 ml may identify patients with a higher possibility to achieve independence and a higher risk of death at 90 days, respectively.
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Affiliation(s)
- Isabelle Mourand
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France.
| | - Mehdi Mahmoudi
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Emmanuelle Lebars
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Frederique Pavillard
- Department of Reanimation, Centre Hospitalier Universitaire, Montpellier, France
| | - Cyril Dargazanli
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Julien Labreuche
- Biostatistics department, Centre Hospitalier Universitaire, Lille, France
| | - Nicolas Gaillard
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Adrien Ter Schiphorst
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Imad Derraz
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Denis Sablot
- Neurology department, Centre Hospitalier, Perpignan, France
| | - Lucas Corti
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
| | - Caroline Arquizan
- Neurology Department, Centre Hospitalier Universitaire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Federico Cagnazzo
- Neuroradiology Department, Centre Hospitalier Universitaire, Montpellier, France
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