title: Acute Symptomatic Basilar Artery Stenosis: MR Imaging Predictors of Early Neurologic Deterioration and Long-term Outcomes.
abstract: Purpose To determine clinical, laboratory, and radiologic factors associated with early neurologic deterioration (END) and long-term outcomes in patients with medically treated symptomatic basilar artery stenosis (BAS). Materials and Methods The study design was approved by the institutional review board. From a database of all consecutive patients with cerebrovascular ischemia, the authors retrospectively included 292 patients with medically treated symptomatic BAS with at least 70% stenosis of the basilar artery. The authors evaluated various clinical factors, including National Institutes of Health Stroke Scale (NIHSS) score, C-reactive protein (CRP) level, fibrinogen level, and radiologic factors, including diffusion-weighted (DW) magnetic resonance (MR) imaging-based posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), hyperintense basilar artery at fluid-attenuated inversion recovery (FLAIR) imaging (FLAIR-hyperintense vessel [FHV]), and clot signs. The outcomes were defined as the development of END and with the 90-day modified Rankin Scale score (favorable score: 0-2). The authors performed a χ(2) test, followed by logistic regression analysis, to identify independent outcome predictors. Results The development of END was highly correlated with unfavorable 90-day modified Rankin Scale score (P < .001). The significant predictors for END were CRP level of at least 1.5 mg/dL (P < .001), NIHSS score of at least 4 (P = .002), pc-ASPECTS of 6 or less (P < .001), and proximal FHV (P = .022). Proximal FHV (P = .010), pc-ASPECTS of 6 or less (P = .002), brainstem involvement (P = .036), and NIHSS score of at least 4 (P < .001) were associated with an unfavorable 90-day modified Rankin Scale score. Neither aggressive medical treatment nor delayed intervention was associated with a favorable 90-day modified Rankin Scale score. Conclusion In medically treated symptomatic BAS, MR imaging parameters such as proximal basilar FHV and DW imaging-based pc-ASPECTS have independent prognostic values for END development and long-term outcomes. (©) RSNA, 2016.
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Woo-Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Keun-Hwa
authors.initials: KH
authors.lastname: Jung
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Ryu
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Keon-Joo
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Soon-Tae
authors.initials: ST
authors.lastname: Lee
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Kon
authors.initials: K
authors.lastname: Chu
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Sang Kun
authors.initials: SK
authors.lastname: Lee
authors.affiliation: From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., S.K.L.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.).
authors.forename: Jae-Kyu
authors.initials: JK
authors.lastname: Roh
mesh_terms: D000208:Acute Disease; D000368:Aged; D001488:Basilar Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*