Acute basilar artery occlusion

diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies.

Jill L. Ostrem, Jeffrey L. Saver, Jeffry R. Alger, Sidney Starkman, Megan C. Leary, Gary Duckwiler, Reza Jahan, Paul Vespa, J. Pablo Villablanca, Y. Pierre Gobin, Fernando Vinuela, Stella Kidwell

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Abstract

BACKGROUND AND PURPOSE: Diffusion-perfusion MRI in patients with anterior circulation occlusions has demonstrated salvage of threatened tissue after thrombolytic therapy. Similar studies have not been reported with posterior circulation occlusions. METHODS: Patients with acute basilar artery occlusion treated with intra-arterial thrombolytics were studied with multimodal MRI before treatment, several hours after treatment, and at day 7. RESULTS: Ten patients were studied (9 men, 1 woman). Mean age was 70 years, and median pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 14. In 6 patients imaged before treatment and at day 7, mean pretreatment diffusion-weighted imaging (DWI) lesion volume was 11 cm(3), and day 7, lesion volume was 2.6 cm(3). Significant mismatch was visualized in all 5 patients with pretreatment perfusion-diffusion imaging (mean, 73%; range, 49% to 99%). Late imaging obtained in 4 of these 5 patients demonstrated that mean posttreatment DWI lesion volume (21 cm(3)) was less than the mean initial perfusion lesion volume (62 cm(3)). Although there was no direct correlation between pretreatment DWI volume and initial NIHSS (r=-0.113), there was good correlation between pretreatment perfusion-weighted imaging volume and initial NIHSS (r=0.72). CONCLUSIONS: In this first report of diffusion-perfusion MRI in patients with acute basilar artery occlusions treated with intra-arterial thrombolysis, significant mismatch was visualized on pretreatment studies, suggesting that large volumes of salvageable tissue were present. Final infarct volumes were smaller than pretreatment perfusion volumes, suggesting that substantial volumes of tissue were salvaged by thrombolytic reperfusion.

Original languageEnglish (US)
JournalStroke
Volume35
Issue number2
StatePublished - 2004
Externally publishedYes

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Basilar Artery
Diffusion Magnetic Resonance Imaging
Perfusion
Stroke
National Institutes of Health (U.S.)
Perfusion Imaging
Therapeutics
Thrombolytic Therapy
Reperfusion

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Acute basilar artery occlusion : diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies. / Ostrem, Jill L.; Saver, Jeffrey L.; Alger, Jeffry R.; Starkman, Sidney; Leary, Megan C.; Duckwiler, Gary; Jahan, Reza; Vespa, Paul; Villablanca, J. Pablo; Gobin, Y. Pierre; Vinuela, Fernando; Kidwell, Stella.

In: Stroke, Vol. 35, No. 2, 2004.

Research output: Contribution to journalArticle

Ostrem, JL, Saver, JL, Alger, JR, Starkman, S, Leary, MC, Duckwiler, G, Jahan, R, Vespa, P, Villablanca, JP, Gobin, YP, Vinuela, F & Kidwell, S 2004, 'Acute basilar artery occlusion: diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies.', Stroke, vol. 35, no. 2.
Ostrem, Jill L. ; Saver, Jeffrey L. ; Alger, Jeffry R. ; Starkman, Sidney ; Leary, Megan C. ; Duckwiler, Gary ; Jahan, Reza ; Vespa, Paul ; Villablanca, J. Pablo ; Gobin, Y. Pierre ; Vinuela, Fernando ; Kidwell, Stella. / Acute basilar artery occlusion : diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies. In: Stroke. 2004 ; Vol. 35, No. 2.
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title = "Acute basilar artery occlusion: diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies.",
abstract = "BACKGROUND AND PURPOSE: Diffusion-perfusion MRI in patients with anterior circulation occlusions has demonstrated salvage of threatened tissue after thrombolytic therapy. Similar studies have not been reported with posterior circulation occlusions. METHODS: Patients with acute basilar artery occlusion treated with intra-arterial thrombolytics were studied with multimodal MRI before treatment, several hours after treatment, and at day 7. RESULTS: Ten patients were studied (9 men, 1 woman). Mean age was 70 years, and median pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 14. In 6 patients imaged before treatment and at day 7, mean pretreatment diffusion-weighted imaging (DWI) lesion volume was 11 cm(3), and day 7, lesion volume was 2.6 cm(3). Significant mismatch was visualized in all 5 patients with pretreatment perfusion-diffusion imaging (mean, 73{\%}; range, 49{\%} to 99{\%}). Late imaging obtained in 4 of these 5 patients demonstrated that mean posttreatment DWI lesion volume (21 cm(3)) was less than the mean initial perfusion lesion volume (62 cm(3)). Although there was no direct correlation between pretreatment DWI volume and initial NIHSS (r=-0.113), there was good correlation between pretreatment perfusion-weighted imaging volume and initial NIHSS (r=0.72). CONCLUSIONS: In this first report of diffusion-perfusion MRI in patients with acute basilar artery occlusions treated with intra-arterial thrombolysis, significant mismatch was visualized on pretreatment studies, suggesting that large volumes of salvageable tissue were present. Final infarct volumes were smaller than pretreatment perfusion volumes, suggesting that substantial volumes of tissue were salvaged by thrombolytic reperfusion.",
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T1 - Acute basilar artery occlusion

T2 - diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies.

AU - Ostrem, Jill L.

AU - Saver, Jeffrey L.

AU - Alger, Jeffry R.

AU - Starkman, Sidney

AU - Leary, Megan C.

AU - Duckwiler, Gary

AU - Jahan, Reza

AU - Vespa, Paul

AU - Villablanca, J. Pablo

AU - Gobin, Y. Pierre

AU - Vinuela, Fernando

AU - Kidwell, Stella

PY - 2004

Y1 - 2004

N2 - BACKGROUND AND PURPOSE: Diffusion-perfusion MRI in patients with anterior circulation occlusions has demonstrated salvage of threatened tissue after thrombolytic therapy. Similar studies have not been reported with posterior circulation occlusions. METHODS: Patients with acute basilar artery occlusion treated with intra-arterial thrombolytics were studied with multimodal MRI before treatment, several hours after treatment, and at day 7. RESULTS: Ten patients were studied (9 men, 1 woman). Mean age was 70 years, and median pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 14. In 6 patients imaged before treatment and at day 7, mean pretreatment diffusion-weighted imaging (DWI) lesion volume was 11 cm(3), and day 7, lesion volume was 2.6 cm(3). Significant mismatch was visualized in all 5 patients with pretreatment perfusion-diffusion imaging (mean, 73%; range, 49% to 99%). Late imaging obtained in 4 of these 5 patients demonstrated that mean posttreatment DWI lesion volume (21 cm(3)) was less than the mean initial perfusion lesion volume (62 cm(3)). Although there was no direct correlation between pretreatment DWI volume and initial NIHSS (r=-0.113), there was good correlation between pretreatment perfusion-weighted imaging volume and initial NIHSS (r=0.72). CONCLUSIONS: In this first report of diffusion-perfusion MRI in patients with acute basilar artery occlusions treated with intra-arterial thrombolysis, significant mismatch was visualized on pretreatment studies, suggesting that large volumes of salvageable tissue were present. Final infarct volumes were smaller than pretreatment perfusion volumes, suggesting that substantial volumes of tissue were salvaged by thrombolytic reperfusion.

AB - BACKGROUND AND PURPOSE: Diffusion-perfusion MRI in patients with anterior circulation occlusions has demonstrated salvage of threatened tissue after thrombolytic therapy. Similar studies have not been reported with posterior circulation occlusions. METHODS: Patients with acute basilar artery occlusion treated with intra-arterial thrombolytics were studied with multimodal MRI before treatment, several hours after treatment, and at day 7. RESULTS: Ten patients were studied (9 men, 1 woman). Mean age was 70 years, and median pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 14. In 6 patients imaged before treatment and at day 7, mean pretreatment diffusion-weighted imaging (DWI) lesion volume was 11 cm(3), and day 7, lesion volume was 2.6 cm(3). Significant mismatch was visualized in all 5 patients with pretreatment perfusion-diffusion imaging (mean, 73%; range, 49% to 99%). Late imaging obtained in 4 of these 5 patients demonstrated that mean posttreatment DWI lesion volume (21 cm(3)) was less than the mean initial perfusion lesion volume (62 cm(3)). Although there was no direct correlation between pretreatment DWI volume and initial NIHSS (r=-0.113), there was good correlation between pretreatment perfusion-weighted imaging volume and initial NIHSS (r=0.72). CONCLUSIONS: In this first report of diffusion-perfusion MRI in patients with acute basilar artery occlusions treated with intra-arterial thrombolysis, significant mismatch was visualized on pretreatment studies, suggesting that large volumes of salvageable tissue were present. Final infarct volumes were smaller than pretreatment perfusion volumes, suggesting that substantial volumes of tissue were salvaged by thrombolytic reperfusion.

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M3 - Article

VL - 35

JO - Stroke

JF - Stroke

SN - 0039-2499

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