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

• Published in: Neuroradiology Vol. 64; no. 6; pp. 1231 - 1238
• Main Authors: Mourand, Isabelle, Mahmoudi, Mehdi, Lebars, Emmanuelle, Pavillard, Frederique, Dargazanli, Cyril, Labreuche, Julien, Gaillard, Nicolas, Ter Schiphorst, Adrien, Derraz, Imad, Sablot, Denis, Corti, Lucas, Costalat, Vincent, Arquizan, Caroline, Cagnazzo, Federico
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2022; Springer Nature B.V; Springer Verlag
• Subjects: 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; Predictive Value of Tests; Radiology; Reperfusion; Retrospective Studies; Sensitivity; Treatment Outcome; Cerebrovascular ischemia; Stroke; Interventional neuroradiology; MR diffusion
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-021-02849-x

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.