title: Endovascular recanalisation therapy for prolonged basilar artery occlusion based on clinical-diffusion MRI mismatch.
abstract: OBJECTIVE
  Clinical-diffusion magnetic resonance imaging (MRI) mismatch (CDM) in patients with anterior circulation occlusions is an optional method used to select patients for recanalisation outside the 3-h time window. A similar concept has not been reported with posterior circulation occlusions.
  
  
  METHODS
  CDM was defined as a Glasgow Coma Scale (GCS) score <8 with DWI lesions not located in the dorsal pons, midbrain or thalamus at the time of admission. Eligible patients were treated with endovascular recanalisation therapy (ERT). The treatment included intra-arterial rt-PA thrombolysis and angioplasty and stenting performed separately or combined. The recanalisation result was assessed by angiography immediately after the treatment according to the trial reports in the Thrombolysis in Myocardial Infarction Criteria (TIMI). The complications and outcome 3 months later were recorded.
  
  
  RESULTS
  Nine patients with a mean age of 66.6 years were included in the study (7 men and 2 women). The median durations of clinical presentation and coma were 31 h (range 25-53 h) and 6 h (range 2-13 h). The median GCS score at admission was 6 (range 4-7). Occlusions were located in the proximal basilar artery (BA) (n=2) and the middle BA (n=7). ERT was successful in 8 patients (TIMI 2, n=2 and TIMI 3, n=6) but failed in 1 patient because recanalisation was not possible (TIMI 0). No intracranial haemorrhage or dissections occurred during treatment. The recanalised patients recovered consciousness within 9-27 h after treatment. The median GCS score upon discharge was 14 (range 3-15). Three months later, 6 patients had a good outcome (modified Rankin Score (mRS) 0-2), and 2 patients had a moderate outcome (mRS 3). The patient who did not undergo recanalisation died in the rehabilitation hospital 21 days later.
  
  
  CONCLUSIONS
  CDM may be a valid method for selecting patients with prolonged basilar artery occlusion (BAO) who are eligible for recanalisation treatment. ERT was feasible for patients with BAO. A good clinical outcome was achieved with successful recanalisation.
authors.affiliation: Department of Neurology, Third Affiliated Hospital, Soochow University, Changzhou 213003, China.
authors.forename: Xuegan
authors.initials: X
authors.lastname: Lian
authors.forename: Debing
authors.initials: D
authors.lastname: Xu
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: Min
authors.initials: M
authors.lastname: Lin
authors.forename: Qin
authors.initials: Q
authors.lastname: Yin
authors.forename: Gelin
authors.initials: G
authors.lastname: Xu
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
authors.forename: Renliang
authors.initials: R
authors.lastname: Zhang
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000628:therapy; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000601:surgery; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000601:surgery*