title: Functional Independence following Endovascular Treatment for Basilar Artery Occlusion despite Extensive Bilateral Pontine Infarcts on Diffusion-Weighted Imaging: Refuting a Self-Fulfilling Prophecy.
abstract: OBJECTIVE
  Extensive brainstem diffusion-weighted imaging (DWI) hyperintensity has been associated with poor outcomes. We aim at documenting a series of patients with extensive DWI pontine lesions who achieved independence following endovascular therapy and aggressive medical therapy in the setting of posterior circulation basilar artery occlusion (BAO).
  
  
  METHODS
  This is a retrospective endovascular database review of a single-operator experience over a 9-year period for patients with (1) complete BAO, (2) extensive bilateral pontine DWI changes and (3) 90-day modified Rankin scale 0-2.
  
  
  RESULTS
  Three out of a total of 40 patients met the inclusion criteria. Case 1 was an 18-year-old male with National Institutes of Health Stroke Scale (NIHSS) 32 on admission, treated 25 h after symptom onset. Case 2 was a 56-year-old male with NIHSS 19, treated 10 h after onset. Case 3 was a 73-year-old male with NIHSS 29, treated 6 h after onset. Full endovascular reperfusion was achieved in all 3 patients. A literature review identified 9 additional cases of extensive pontine DWI changes and good outcome. These patients were young (32 ± 22 years), mostly males (69%), presented with a relatively low posterior circulation Acute Stroke Prognosis Early CT Score (6 ± 1), were treated relatively late from last known normal (13 ± 10 h) and were mostly (84%) treated with endovascular intervention.
  
  
  CONCLUSIONS
  Extensive bilateral pontine DWI lesions among patients with BAO are not an unequivocal indicator of poor prognosis. We advise strong caution when considering these findings in the treatment decision algorithm.
authors: Marcus Stroke &amp; Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga., USA.
authors: Diogo C
authors: DC
authors: Haussen
authors: Marcus Stroke &amp; Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga., USA.
authors: Renato A C
authors: RA
authors: Oliveira
authors: Marcus Stroke &amp; Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga., USA.
authors: Vikas
authors: V
authors: Patel
authors: Marcus Stroke &amp; Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga., USA.
authors: Raul G
authors: RG
authors: Nogueira
keywords: Basilar artery; Cerebrovascular occlusion; Diffusion MR imaging; Patient outcome assessment; Pons; Stroke