Background and Purpose:Prognostic factors for outcome of endovascular treatment remains to be investigated in patients with acute basilar artery occlusion. We aimed to assess the prognostic value of a novel pretreatment diffusion-weighted imaging score: The Pons-Midbrain and Thalamus (PMT) score.Methods:Eligible patients who underwent endovascular treatment due to acute basilar artery occlusion were reviewed. The PMT score was a diffusion-weighted imaging–based semiquantitative scale in which the infarctions of pons, midbrain, and thalamus were fully considered. The PMT score was assessed as well as the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score and Brain Stem Score. Good outcomes were defined as a modified Rankin Scale score of ≤3 at 90-day and successful reperfusion as Thrombolysis in Cerebral Infarction grades 2b/3. The associations between baseline clinical parameters and good outcomes were evaluated with logistic regression.Results:A total of 107 patients with pretreatment magnetic resonance imaging were included in this cohort. The baseline PMT score (median [interquartile range], 3 [1–5] versus 7 [5–9]; P<0.001) and Brain Stem Score (median [interquartile range], 2 [1–4] versus 3 [2–5]; P=0.001) were significantly lower in good outcome group; the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was higher in good outcome group without statistical significance. As a result of receiver operating characteristic curve analyses, the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score showed poor prognostic accuracy for good outcome (area under the curve, 0.60 [95% CI, 0.49–0.71]; P=0.081); The baseline PMT score showed significantly better prognostic accuracy for 90-day good outcome than the Brain Stem Score and National Institutes of Health Stroke Scale (area under the curve, 0.80 versus 0.68 versus 0.78, P=0.003). In addition, favorable PMT score <7 (odds ratio, 22.0 [95% CI, 6.0–80.8], P<0.001), Brain Stem Score <3 (odds ratio, 4.65 [95% CI, 2.05–10.55], P<0.001) and baseline National Institutes of Health Stroke Scale <23 (odds ratio, 8.0 [95% CI, 2.5–25.6], P<0.001) were associated with improved good outcome.Conclusions:In patients with acute basilar artery occlusion following endovascular treatment, the pretreatment diffusion-weighted imaging based PMT score showed good prognostic value for clinical outcome.

中文翻译：

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新型弥散加权成像评分对血管内治疗后急性基底动脉闭塞显示出良好的预后价值：脑桥-中脑和丘脑评分

背景和目的：急性基底动脉闭塞患者血管内治疗结果的预后因素仍有待研究。我们旨在评估一种新的治疗前弥散加权成像评分的预后价值：脑桥中脑和丘脑 (PMT) 评分。方法：对因急性基底动脉闭塞而接受血管内治疗的合格患者进行回顾。PMT 评分是一种基于弥散加权成像的半定量量表，其中充分考虑了脑桥、中脑和丘脑的梗塞。评估 PMT 评分以及后循环急性卒中预后早期计算机断层扫描评分和脑干评分。良好结果定义为 90 天时改良 Rankin 量表评分≤3 和成功再灌注为脑梗死溶栓 2b/3 级。使用逻辑回归评估基线临床参数和良好结果之间的关联。结果：共有 107 名接受治疗前磁共振成像的患者被纳入该队列。基线 PMT 评分（中位数 [四分位距]，3 [1-5] 对 7 [5-9]；P <0.001）和脑干评分（中位数[四分位距]，2 [1-4] vs 3 [2-5]；P = 0.001）在良好结果组中显着降低；预后良好组的后循环急性卒中预后早期计算机断层扫描评分较高，无统计学意义。作为接受者操作特征曲线分析的结果，后循环急性卒中预后早期计算机断层扫描评分显示良好预后的预后准确性较差（曲线下面积，0.60 [95% CI，0.49-0.71]；P = 0.081）；基线 PMT 评分显示 90 天良好预后的预后准确性明显优于脑干评分和美国国立卫生研究院卒中量表（曲线下面积，0.80 对 0.68 对 0.78，P=0.003)。此外，有利的 PMT 评分 <7（优势比，22.0 [95% CI，6.0–80.8]，P <0.001），脑干评分 <3（优势比，4.65 [95% CI，2.05–10.55]，P < 0.001）和基线美国国立卫生研究院卒中量表 <23（优势比，8.0 [95% CI，2.5-25.6]，P <0.001）与改善良好结果相关。结论：在血管内治疗后急性基底动脉闭塞的患者中, 基于 PMT 评分的预处理扩散加权成像对临床结果显示出良好的预后价值。