{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:36:47Z","timestamp":1793039807330,"version":"4.5.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of a prospective multicenter stroke registry in France, including consecutive patients (2017\u20132024) 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\u20133 versus 4\u20136). 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 \u226410.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 201 patients (median age, 70; NIHSS score, 10), 97 (48.3%) had a poor outcome. Despite a small median infarct volume (4.75 mL), disconnected fiber volume was substantial (median 25.15 mL). Disconnected fiber volume achieved an area under the receiver operating characteristic curves of 0.84, outperforming NIHSS score (0.67;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001), infarct volume (0.75;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.00059), and posterior circulation Alberta Stroke Program Early Computed Tomography Score (0.76;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.0127). Patients without significant disconnection had better outcomes across the full modified Rankin Scale spectrum (odds ratio, 0.12 [95% CI, 0.065\u20130.204]) and derived greater benefit from successful recanalization (odds ratio, 0.33 [95% CI, 0.15\u20130.70]). In patients with an NIHSS score \u226410 (n=102), disconnected fiber volume remained the strongest predictor (area under the receiver operating characteristic curves of 0.83).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03776877.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.056382","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T09:00:19Z","timestamp":1789117219000},"page":"3280-3291","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["High-Resolution Disconnectome Predicts Outcome and Response to Thrombectomy in Basilar Artery Occlusion"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct03776877","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Benjamin","family":"Authamayou","sequence":"first","affiliation":[{"name":"Neuroimagerie Diagnostique et Th\u00e9rapeutique, CHU de Bordeaux, France (B.A., G.M., A.L., O.E., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7611-7753","authenticated-orcid":true,"given":"Gaultier","family":"Marnat","sequence":"additional","affiliation":[{"name":"Neuroimagerie Diagnostique et Th\u00e9rapeutique, CHU de Bordeaux, France (B.A., G.M., A.L., O.E., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3699-7271","authenticated-orcid":true,"given":"Anna","family":"Matsulevits","sequence":"additional","affiliation":[{"name":"Groupe d\u2019Imagerie Neurofonctionnelle, Institut des Maladies Neurod\u00e9g\u00e9n\u00e9ratives-UMR 5293, CNRS, CEA, University of Bordeaux, France (A.M., C.F., M.T.S.)."},{"name":"Brain Connectivity and Behaviour Laboratory, Bordeaux, France (A.M., C.F., M.T.S., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7144-8617","authenticated-orcid":true,"given":"Fanny","family":"Munsch","sequence":"additional","affiliation":[{"name":"University of Bordeaux, Institut de Bio-imagerie IBIO, France (F.M., A.L., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6963-2060","authenticated-orcid":true,"given":"Audrey","family":"Lavielle","sequence":"additional","affiliation":[{"name":"Neuroimagerie Diagnostique et Th\u00e9rapeutique, CHU de Bordeaux, France (B.A., G.M., A.L., O.E., T.T.)."},{"name":"University of Bordeaux, Institut de Bio-imagerie IBIO, France (F.M., A.L., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3296-4544","authenticated-orcid":true,"given":"Nad\u00e8ge","family":"Corbin","sequence":"additional","affiliation":[{"name":"University of Bordeaux, Centre de R\u00e9sonance Magn\u00e9tique des Syst\u00e8mes Biologiques, UMR5536, CNRS, France (N.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7822-2653","authenticated-orcid":true,"given":"Chris","family":"Foulon","sequence":"additional","affiliation":[{"name":"Groupe d\u2019Imagerie Neurofonctionnelle, Institut des Maladies Neurod\u00e9g\u00e9n\u00e9ratives-UMR 5293, CNRS, CEA, University of Bordeaux, France (A.M., C.F., M.T.S.)."},{"name":"Brain Connectivity and Behaviour Laboratory, Bordeaux, France (A.M., C.F., M.T.S., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1038-7846","authenticated-orcid":true,"given":"Bailiang","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Nancy, Inserm CIC-IT U1433, France (B.C., E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9219-7807","authenticated-orcid":true,"given":"Emilien","family":"Micard","sequence":"additional","affiliation":[{"name":"University of Nancy, Inserm CIC-IT U1433, France (B.C., E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-4464","authenticated-orcid":true,"given":"Benjamin","family":"Gory","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Lorraine, France (B.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8146-5886","authenticated-orcid":true,"given":"Vincent","family":"L\u2019Allinec","sequence":"additional","affiliation":[{"name":"Radiology Department, Centre Hospitalier Universitaire d\u2019Angers, France (V.L.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6506-4019","authenticated-orcid":true,"given":"Romain","family":"Bourcier","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, CHU Nantes, France (R.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9544-379X","authenticated-orcid":true,"given":"Olivier","family":"Naggara","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, H\u00f4pital Sainte Anne, GHU-Paris Psychiatrie et Neurosciences, France (O.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8853-1015","authenticated-orcid":true,"given":"Eliot","family":"Lauze","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Piti\u00e9 Salp\u00eatri\u00e8re Hospital, Paris, France (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8422-9205","authenticated-orcid":true,"given":"Gr\u00e9goire","family":"Boulouis","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Neuroradiology, Tours University Hospital, and Imaging Brain &amp; Neuropsychiatry iBraiN, INSERM U1253, France (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8993-2175","authenticated-orcid":true,"given":"Bertrand","family":"Lapergue","sequence":"additional","affiliation":[{"name":"H\u00f4pital FOCH, Service de Neurologie et Unit\u00e9 de Neuro Vasculaire, Suresnes, France (B.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5696-5368","authenticated-orcid":true,"given":"Omer","family":"Eker","sequence":"additional","affiliation":[{"name":"Neuroimagerie Diagnostique et Th\u00e9rapeutique, CHU de Bordeaux, France (B.A., G.M., A.L., O.E., T.T.)."},{"name":"University of Bordeaux, INSERM, Neurocentre Magendie, France (O.E., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1171-4215","authenticated-orcid":true,"given":"Igor","family":"Sibon","sequence":"additional","affiliation":[{"name":"CHU de Bordeaux, Unit\u00e9 neurovasculaire, Bordeaux, France (I.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-1814","authenticated-orcid":true,"given":"Michel","family":"Thiebaut de Schotten","sequence":"additional","affiliation":[{"name":"Groupe d\u2019Imagerie Neurofonctionnelle, Institut des Maladies Neurod\u00e9g\u00e9n\u00e9ratives-UMR 5293, CNRS, CEA, University of Bordeaux, France (A.M., C.F., M.T.S.)."},{"name":"Brain Connectivity and Behaviour Laboratory, Bordeaux, France (A.M., C.F., M.T.S., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7151-6325","authenticated-orcid":true,"given":"Thomas","family":"Tourdias","sequence":"additional","affiliation":[{"name":"Neuroimagerie Diagnostique et Th\u00e9rapeutique, CHU de Bordeaux, France (B.A., G.M., A.L., O.E., T.T.)."},{"name":"Brain Connectivity and Behaviour Laboratory, Bordeaux, France (A.M., C.F., M.T.S., T.T.)."},{"name":"University of Bordeaux, Institut de Bio-imagerie IBIO, France (F.M., A.L., T.T.)."},{"name":"University of Bordeaux, INSERM, Neurocentre Magendie, France (O.E., T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ETIS Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70229-0"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2206317"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2207576"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.040807"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2030297"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000513"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awaf013"},{"key":"e_1_3_3_9_2","first-page":"274","article-title":"Stroke outcome prediction using admission NIHSS in anterior and posterior circulation stroke.","volume":"33","author":"Kazi SA","year":"2021","unstructured":"Kazi SA, Siddiqui M, Majid S. Stroke outcome prediction using admission NIHSS in anterior and posterior circulation stroke. J Ayub Med Coll Abbottabad. 2021;33:274\u2013278.","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.034019"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.511162"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246906"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032314"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.abq2591"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.46075"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awad013"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/15910199221106049"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/gigascience\/giy004"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-18920-9"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00429-022-02589-5"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-017-01285-x"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0730-725x(01)00415-5"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-29525-0"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.013"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(19)30395-3"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2010.09.025"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2011.09.015"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00429-015-1001-3"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.22024"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-8119(03)00336-7"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2004.07.051"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1038\/nn.2905"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.22080"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00429-015-1179-4"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2013.05.012"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.94902"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.200410135"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-018-1032-5"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-024-03667-5"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000154856.42135.85"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011208"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3870"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26272"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000196957.55928.ab"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcae338"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1604267"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.045154"},{"key":"e_1_3_3_48_2","unstructured":"World Health Organization. Total density of MRI per million population. Accessed August 15 2026. https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/total-density-per-million-population-magnetic-resonance-imaging"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.abm3952"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/SVIN.125.002110"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.126.056382","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:01:06Z","timestamp":1793037666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.126.056382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":49,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1161\/STROKEAHA.126.056382"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.126.056382","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"2026-04-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}