High-Resolution Disconnectome Predicts Outcome and Response to Thrombectomy in Basilar Artery Occlusion

BACKGROUND: Acute basilar artery occlusion causes devastating strokes. Despite the benefit of endovascular treatment, the optimal management remains controversial in specific subgroups, particularly patients with mild deficits, and would benefit from robust prognostic tools. Given the dense white matter networks within the posterior fossa, we tested whether quantifying disconnections from acute diffusion-weighted imaging could improve outcome prediction and identify responders to recanalization compared with conventional metrics. METHODS: We conducted a secondary analysis of a prospective multicenter stroke registry in France, including consecutive patients (2017-2024) with basilar artery occlusion and admission magnetic resonance imaging. Ultra-high-resolution diffusion magnetic resonance imaging was acquired in 2 healthy participants to build normative tractograms with optimized posterior fossa quality. Patient infarcts delineated on diffusion-weighted imaging were projected onto these tractograms to estimate disconnected fiber volume. The primary outcome was 90-day modified Rankin Scale score (0-3 versus 4-6). Predictive performance of disconnected fiber volume was compared with baseline National Institutes of Health Stroke Scale (NIHSS), infarct volume, and posterior circulation Alberta Stroke Program Early Computed Tomography Score using logistic regressions and area under the receiver operating characteristic curves. Ordinal regressions tested associations between dichotomized disconnection status and the full modified Rankin Scale spectrum, stratified by recanalization status. Analyses were repeated in patients with an NIHSS score ≤10. RESULTS: =0.0127). Patients without significant disconnection had better outcomes across the full modified Rankin Scale spectrum (odds ratio, 0.12 [95% CI, 0.065-0.204]) and derived greater benefit from successful recanalization (odds ratio, 0.33 [95% CI, 0.15-0.70]). In patients with an NIHSS score ≤10 (n=102), disconnected fiber volume remained the strongest predictor (area under the receiver operating characteristic curves of 0.83). CONCLUSIONS: Disconnected fiber volume derived indirectly is a robust prognostic marker of basilar artery occlusion outcomes that outperforms conventional predictors and may support future treatment decisions after prospective validation. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT03776877.

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Journal
Stroke
Published
2026-09-11
DOI
https://doi.org/10.1161/strokeaha.126.056382
Primary Topic
Advanced Neuroimaging Techniques and Applications
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article
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article

High-Resolution Disconnectome Predicts Outcome and Response to Thrombectomy in Basilar Artery Occlusion

Julia Fontaine, Gioia Mione, Bailiang Chen, Charline Benoit et al.
Stroke
Advanced Neuroimaging Techniques and Applications
article

High-Resolution Disconnectome Predicts Outcome and Response to Thrombectomy in Basilar Artery Occlusion

Julia Fontaine, Gioia Mione, Bailiang Chen, Charline Benoit, Jean Papaxanthos, Laurent Derex, Simon Escalard, William Boisseau, Elodie Ong, Alessandro Sgreccia, Benjamin Gory, Marcela Voicu, Audrey Lavielle, Marian Douarinou, Amira Al Raaisi, Waliyde Jabeur, Morgane Laubacher, Vincent L’Allinec, Omer Eker, Marie Reitter, Michaël Obadia, Matteo Cappucci, Iona Podar, Chris Foulon, Arthur Lionnet, François Delvoye, Lisa Humbertjean-Selton, Gaultier Marnat, Benjamin Daumas Duport, Fanny Munsch, M. Hermier, Silvia Pizzuto, Grégoire Boulouis, Federico Di Maria, Cécile Preterre, Solène de Gaalon, Romain Bourcier, Lucie Rascle, Thomas Tourdias, Andrea Filip, Agnès Masson, Olivier Naggara, Bertrand Lapergue, Lisa Papillon, Anna Matsulevits, Mikael Mazhigi, Grace Adwan, Mehdi Beyragued, Ameli Roxanna, E MICARD, Adrien Wang, Michel Thiebaut de Schotten, Pierre Louis Alexandre, Grégoire Barthel, Lionel Alb, Eliot Lauze, David Weisenburger-Lile, Alexandre Bani-Sadr, Nadège Courbin, Igor Paul Sibon, Benjamin Authamayou, Georges Rodesch, Hocine REDJEM, Madalina BREZEANU, Stanislas SMAJDA, François ZHU, Jean-Sébastien LIEGEY, Jean-Philippe DESILLES, Benjamin MAIER, Raphaël BLANC, Gérard AUDIBERT, Tae-Hee CHO, Marine BEAUMONT, Françis TURJMAN, Pierre BRIAU, TCHIKVILADZE Maia, Yves BERTHEZENE, Benoît GUILLON, Cédric LENOBLE, Michel PIOTIN, Laura MECHTOUFF, Oguzhan COSKUN, Roberto RIVA, Norbert NIGHOGHOSSIAN, Xavier BARREAU, Guillaume TESSIER, Sophie PLANEL, Jean-Christophe LACOUR, Candice SABBEN, Anne-Laure DERELLE, Arturo CONSOLI, Hubert DESAL, René ANXIONNAT, Liang LIAO, Pierre SENERS, Emmanuelle SCHMITT, Adriana TABARNA, Lucas GORZA, Sébastien RICHARD, Serge EVRARD
article en

Abstract

BACKGROUND: Acute basilar artery occlusion causes devastating strokes. Despite the benefit of endovascular treatment, the optimal management remains controversial in specific subgroups, particularly patients with mild deficits, and would benefit from robust prognostic tools. Given the dense white matter networks within the posterior fossa, we tested whether quantifying disconnections from acute diffusion-weighted imaging could improve outcome prediction and identify responders to recanalization compared with conventional metrics. METHODS: We conducted a secondary analysis of a prospective multicenter stroke registry in France, including consecutive patients (2017-2024) with basilar artery occlusion and admission magnetic resonance imaging. Ultra-high-resolution diffusion magnetic resonance imaging was acquired in 2 healthy participants to build normative tractograms with optimized posterior fossa quality. Patient infarcts delineated on diffusion-weighted imaging were projected onto these tractograms to estimate disconnected fiber volume. The primary outcome was 90-day modified Rankin Scale score (0-3 versus 4-6). Predictive performance of disconnected fiber volume was compared with baseline National Institutes of Health Stroke Scale (NIHSS), infarct volume, and posterior circulation Alberta Stroke Program Early Computed Tomography Score using logistic regressions and area under the receiver operating characteristic curves. Ordinal regressions tested associations between dichotomized disconnection status and the full modified Rankin Scale spectrum, stratified by recanalization status. Analyses were repeated in patients with an NIHSS score ≤10. RESULTS: =0.0127). Patients without significant disconnection had better outcomes across the full modified Rankin Scale spectrum (odds ratio, 0.12 [95% CI, 0.065-0.204]) and derived greater benefit from successful recanalization (odds ratio, 0.33 [95% CI, 0.15-0.70]). In patients with an NIHSS score ≤10 (n=102), disconnected fiber volume remained the strongest predictor (area under the receiver operating characteristic curves of 0.83). CONCLUSIONS: Disconnected fiber volume derived indirectly is a robust prognostic marker of basilar artery occlusion outcomes that outperforms conventional predictors and may support future treatment decisions after prospective validation. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT03776877.

Stroke
Université de Tours (FR), Centre National de la Recherche Scientifique (FR), Université de Bordeaux (FR), Inserm (FR), Deutsche Telekom (Austria) (AT), Commissariat à l'Énergie Atomique et aux Énergies Alternatives (FR), Centre Hospitalier Universitaire de Bordeaux (FR), Centre Hospitalier Universitaire de Nantes (FR), Sorbonne Université (FR), Institut des Maladies Neurodégénératives (FR), Imaging, Brain, and Neuropsychiatry (FR), Centre d’Investigation Clinique Innovation Technologique de Nancy (FR), Centre de Résonance Magnétique des Systèmes Biologiques (FR), Centre Hospitalier Universitaire d'Angers (FR), Pitié-Salpêtrière Hospital (FR), Centre Hospitalier Sainte-Anne (FR), Neurocentre Magendie (FR), Institut de Biochimie et Génétique Cellulaires (FR), FHU Neurovasc (FR), Hôpital Foch (FR), Université de Lorraine (FR)
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Advanced Neuroimaging Techniques and Applications
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