title: Acute basilar artery occlusion: diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies.
abstract: OBJECTIVE
  Diffusion-perfusion MRI in patients with anterior circulation occlusions has demonstrated salvage of threatened tissue after thrombolytic therapy. Similar studies have not been reported with posterior circulation occlusions.
  
  
  METHODS
  Patients with acute basilar artery occlusion treated with intra-arterial thrombolytics were studied with multimodal MRI before treatment, several hours after treatment, and at day 7.
  
  
  RESULTS
  Ten patients were studied (9 men, 1 woman). Mean age was 70 years, and median pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 14. In 6 patients imaged before treatment and at day 7, mean pretreatment diffusion-weighted imaging (DWI) lesion volume was 11 cm(3), and day 7, lesion volume was 2.6 cm(3). Significant mismatch was visualized in all 5 patients with pretreatment perfusion-diffusion imaging (mean, 73%; range, 49% to 99%). Late imaging obtained in 4 of these 5 patients demonstrated that mean posttreatment DWI lesion volume (21 cm(3)) was less than the mean initial perfusion lesion volume (62 cm(3)). Although there was no direct correlation between pretreatment DWI volume and initial NIHSS (r=-0.113), there was good correlation between pretreatment perfusion-weighted imaging volume and initial NIHSS (r=0.72).
  
  
  CONCLUSIONS
  In this first report of diffusion-perfusion MRI in patients with acute basilar artery occlusions treated with intra-arterial thrombolysis, significant mismatch was visualized on pretreatment studies, suggesting that large volumes of salvageable tissue were present. Final infarct volumes were smaller than pretreatment perfusion volumes, suggesting that substantial volumes of tissue were salvaged by thrombolytic reperfusion.
authors.affiliation: Department of Neurology, UCLA Medical Center, USA. jostrem@itsa.ucsf.edu
authors.forename: Jill L
authors.initials: JL
authors.lastname: Ostrem
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Jeffry R
authors.initials: JR
authors.lastname: Alger
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Megan C
authors.initials: MC
authors.lastname: Leary
authors.forename: Gary
authors.initials: G
authors.lastname: Duckwiler
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.forename: Paul
authors.initials: P
authors.lastname: Vespa
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablanca
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
authors.forename: Fernando
authors.initials: F
authors.lastname: Vinuela
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Kidwell
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007269:Injections, Intra-Arterial; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents