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(Stroke. 2004;35:e30.)
© 2004 American Heart Association, Inc.

Research Reports

Acute Basilar Artery Occlusion

Diffusion-Perfusion MRI Characterization of Tissue Salvage in Patients Receiving Intra-Arterial Stroke Therapies

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

From the Department of Neurology (J.O., J.L.S., J.R.A., S.S., M.C.L., G.D., R.J., P.V., J.P.V., F.V., C.S.K.), Stroke Center (J.L.S., S.S., M.C.L., R.J., P.V., C.S.K.), Department of Radiology (J.R.A, G.D. J.P.V., F.V.), Department of Emergency Medicine (S.S.), and Department of Neurosurgery (P.V.), UCLA Medical Center, Los Angeles, Calif, and Department of Radiology (P.G.), New York Presbyterian-Weill Cornell Medical College, New York.

Correspondence to Jill Ostrem, MD, Department of Neurology, SFVA Medical Center, 4150 Clement St (127-P), San Francisco, CA 94121. E-mail jostrem{at}itsa.ucsf.edu

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 cm³, and day 7, lesion volume was 2.6 cm³. 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 cm³) was less than the mean initial perfusion lesion volume (62 cm³). 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.

Key Words: magnetic resonance imaging, diffusion-weighted • magnetic resonance imaging, perfusion-weighted • penumbra • stroke, ischemic • thrombolytic therapy

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