AUTHOR=Chen Jun , Zhang Jiwei , Zhu Xianjin , Zhang Xuebin , Jiang Bin , Liu Qi , Wei Zheng Z. 

TITLE=Selection of patients with acute vertebrobasilar artery occlusion for endovascular treatment by magnetic resonance imaging

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1084819

DOI=10.3389/fneur.2023.1084819

ISSN=1664-2295

ABSTRACT=Background and purpose: The best mothed for selecting patients with acute vertebrobasilar artery occlusion (VBAO) who would benefit from endovascular treatment (EVT) is still the key question. This study aimed to assess the efficacy of magnetic resonance imaging (MRI) for selecting patients with acute VBAO for EVT.
Materials and methods: Fourteen patients with suspected acute VBAO on MR angiography (MRA) in the EVT database (from April 2016 to August 2019) were enrolled. Acute Stroke Prognosis Early Computed Tomography Score (ASPECTS) and pons-midbrain-index was assessed on diffusion-weighted imaging (DWI). EVT included stent retriever and a rescue treatment (angioplasty and/or stenting). The proportion of successful reperfusion and favorable functional outcomes (modified Rankin Scale ≤3) at 90 days was documented.
Results: Eleven patients were included in the final analysis (6 of 11 patients accompanying with vertebral artery occlusion). The median DWI-ASPECTS and pons-midbrain-index was 7 and 2, respectively. Underlying stenosis was detected in 10 of 11 (90.9%) patients. Balloon angioplasty and/or stenting was used as rescue therapy for 5 patients and 2 patients, respectively. Nine patients (81.8%) achieved successful reperfusion (mTICI, 2b or 3). The 90-day mRS score of 0-3 was achieved in 6 (54.5%) patients. Mortality rate within 90 days was 18.2% (2 of 11 patients).
Conclusions: 
DWI plus MRA could help select the patients with acute VBAO for EVT by assessing ASPECTS and pons-midbrain-index. Patients could achieve good reperfusion and favorable functional outcome.