title: Diffusion-weighted imaging score of the brain stem: A predictor of outcome in acute basilar artery occlusion treated with the Solitaire FR device.
abstract: OBJECTIVE
  The prognosis for ischemic stroke due to acute basilar artery occlusion is very poor: Early recanalization remains the main factor that can improve outcomes. The baseline extent of brain stem ischemic damage can also influence outcomes. We evaluated the validity of an easy-to-use DWI score to predict clinical outcome in patients with acute basilar artery occlusion treated by mechanical thrombectomy.
  
  
  METHODS
  We analyzed the baseline clinical and DWI parameters of 31 patients with acute basilar artery occlusion, treated within 24 hours of symptom onset by using a Solitaire FR device. The DWI score of the brain stem was assessed with a 12-point semiquantitative score that separately considered each side of the medulla, pons, and midbrain. Clinical outcome was assessed at 180 days by using the mRS. According to receiver operating characteristic analyses, the cutoff score determined the optimal positive predictive value for outcome. The Spearman rank correlation coefficient assessed the correlation between the DWI brain stem score and baseline characteristics.
  
  
  RESULTS
  Successful recanalization (Thrombolysis in Cerebral Infarction 3-2b) was achieved in 23 patients (74%). A favorable outcome (mRS ≤ 2) was observed in 11 patients (35%). An optimal DWI brain stem score of <3 predicted a favorable outcome. The probability of a very poor outcome (mRS ≥ 5) if the DWI brain stem score was ≥5 reached 80% (positive predictive value) and 100% if this score was ≥6. Interobserver reliability of the DWI brain stem score was excellent, with an intraclass correlation coefficient of 0.97 (95% CI, 0.96-0.99). The DWI brain stem score was significantly associated with baseline tetraplegia (P = .001) and coma (P = .005).
  
  
  CONCLUSIONS
  In patients with acute basilar artery occlusion treated by mechanical thrombectomy, the baseline DWI brain lesion score seems to predict clinical outcome.
authors: From the Departments of Neurology (I.M., C.A., D.M.) i-mourand@chu-montpellier.fr.
authors: I
authors: I
authors: Mourand
authors: Neuroradiology (P.M., V.C., A.B.), University Hospital Center of Montpellier, Gui de Chauliac Hospital, Montpellier, France.
authors: P
authors: P
authors: Machi
authors: Unit of Clinical Research and Epidemiology (E.N., M.-C.P.), Department of Medical Information, University Hospital Center of Montpellier, Lapeyronie Hospital, Montpellier, France.
authors: E
authors: E
authors: Nogué
authors: From the Departments of Neurology (I.M., C.A., D.M.).
authors: C
authors: C
authors: Arquizan
authors: Neuroradiology (P.M., V.C., A.B.), University Hospital Center of Montpellier, Gui de Chauliac Hospital, Montpellier, France.
authors: V
authors: V
authors: Costalat
authors: Unit of Clinical Research and Epidemiology (E.N., M.-C.P.), Department of Medical Information, University Hospital Center of Montpellier, Lapeyronie Hospital, Montpellier, France.
authors: M-C
authors: MC
authors: Picot
authors: Neuroradiology (P.M., V.C., A.B.), University Hospital Center of Montpellier, Gui de Chauliac Hospital, Montpellier, France.
authors: A
authors: A
authors: Bonafé
authors: From the Departments of Neurology (I.M., C.A., D.M.).
authors: D
authors: D
authors: Milhaud
mesh_terms: D001933:Brain Stem / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000473:pathology* / Q000628:therapy*