Predictive Value of a Novel Baseline Diffusion-Weighted Imaging Posterior Circulation Score in Endovascular Treatment of Patients with Acute Vertebrobasilar Occlusion

Rationale and Objectives: To investigate the predictive value of a novel posterior circulation score (novel-PC score) based on baseline posterior circulation diffusion-weighted imaging (DWI) for functional independence after endovascular treatment (EVT) in patients with acute vertebral-basilar artery occlusion (VBAO). Materials and Methods: The baseline DWI brain stem score (BSS), posterior circulation Alberta Stroke Program Early CT Score (pc -ASPECTS), and the novel-PC score were evaluated separately. A modified Rankin scale (mRS) <= 2 at 90 days was defined as a prog-nostic indicator of functional independence. Modified Thrombolysis in Cerebral Infarction grade 2b or 3 was defined as surgical success. Results: A total of 64 eligible patients were enrolled and divided into good and poor functional prognosis groups based on the mRS. The novel -PC score, BSS, and pc-ASPECTS (all P <= .001) were significantly better in the good functional prognosis group. The novel-PC score had a higher predictive value than BSS and pc-ASPECTS for 90-day functional independence (area under the receiver operating characteristic curve, 0.87 vs. 0.73 vs. 0.71; P < .05). Univariate binary logistic regression analysis showed that age (P = .006), Posterior National Institutes of Health Stroke Scale <= 18 (P < .001), BSS <= 2 (P = .008), pc-ASPECTS > 7 (P = .002), and novel-PC score <= 5 (P = .001) were independently associated with function. Conclusion: Our novel-PC score, based on DWI, can independently predict functional prognosis in patients with acute VBAO after EVT. Clinical Relevance: The novel-PC score based on baseline DWI was shown to be an independent predictor of function in patients with acute BVAO who are treated with EVT.