J Korean Neurol Assoc.  2025 Feb;43(1):1-11. 10.17340/jkna.2024.0048.

The Brainstem Score on Diffusion-weighted Imaging before Mechanical Thrombectomy in Acute Basilar Artery Occlusion is a Reliable Predictor for Prognosis: A Comparative Study with Critical Area Perfusion Score on Perfusion MRI

• Seong J
• Kim K
• Lee S
• Lee Y
• Yoon BA
• Kim DH
• Cha JK

• KMID: 2564402
• DOI: http://doi.org/10.17340/jkna.2024.0048

Abstract

Background
This study evaluated the use of brainstem score (BSS) on pre-procedural diffusion-weighted imaging (DWI) to predict outcomes after mechanical thrombectomy (MT) in acute basilar artery occlusion (ABAO) patients and compared its predictive effectiveness to the critical area perfusion score (CAPS) on perfusion magnetic resonance imaging (MRI) using RAPID.
Methods
This study focused on ABAO patients who underwent MT after MRI at Dong-A University Hospital from 2013 to 2023. Ischemic lesion volume and DWI BSS were measured for all. For the group that underwent perfusion MRI using RAPID, CAPS were measured. The primary end point was a poor outcome at 90 days (modified Rankin scale [mRS], >2).
Results
71 patients had ABAO and underwent MT after MRI. The poor outcome group (66.2%) had significantly larger ischemic lesion volume and higher DWI BSS compared with the good outcome group. In the multiple logistic regression analysis, DWI BSS (odds ratio, 8.27; 95% confidence interval, 1.93-35.50; p<0.01) was an independent predictor of poor outcomes. In 26 patients, CAPS was measured on perfusion MRI. In this subgroup, poor outcome group (50.0%) had higher DWI BSS and CAPS than the good outcome group. In the multiple logistic regression analysis, DWI BSS remained a valid independent predictor for predicting outcomes, but CAPS did not function as an independent predictor.
Conclusion
In this study, the DWI BSS before MT in ABAO patients emerged as a useful imaging marker for predicting post-procedural outcomes. Its predictive ability is not only comparable to but even superior to CAPS on perfusion MRI.

Keyword

Acute basilar artery occlusion; Mechanical thrombectomy; Brainstem score; Critical area perfusion score