Journal Article

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

Sablot, Denis, Cagnazzo, Federico, Derraz, Imad, Mourand, Isabelle, Mahmoudi, Mehdi, Gaillard, Nicolas, Ter Schiphorst, Adrien, Costalat, Vincent, Arquizan, Caroline, Corti, Lucas, Labreuche, Julien, Pavillard, Frederique, Dargazanli, Cyril, Lebars, Emmanuelle

2022

Overview

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.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V,Springer Verlag
• Subject: Arterial Occlusive Diseases - surgery / Basilar Artery - diagnostic imaging / Basilar Artery - surgery / Bioengineering / Cardiovascular system / Confidence intervals / Endovascular Procedures / Human health and pathology / Humans / Imaging / Interventional Neuroradiology / Lesions / Life Sciences / Magnetic resonance imaging / Medicine / Medicine & Public Health / Mortality / Neurology / Neurons and Cognition / Neuroradiology / Neurosciences / Neurosurgery / Nuclear medicine / Occlusion / Patients / Radiology / Reperfusion / Retrospective Studies / Sensitivity / Stroke - etiology / Thrombectomy - adverse effects / Treatment Outcome