Basal ganglionic infarction before mechanical thrombectomy predicts poor outcome.
OBJECTIVE
Use of mechanical thrombectomy for acute cerebrovascular occlusions is increasing. Preintervention MRI patterns may be helpful in predicting prognosis.


METHODS
We reviewed all Merci thrombectomy cases of either terminal ICA or M1 occlusions and classified them according to diffusion MRI patterns of (1) completed basal ganglia infarct (pure M1a), (2) near-completed basal ganglia infarct (incomplete M1a), and (3) relative sparing of deep MCA field (M1b). We compared the M1a and M1b patients with respect to neurological deficit on presentation, recanalization rates, hospital length of stay, and disability on discharge. We also determined whether deep MCA compromise predicted hematomal hemorrhagic transformation (HT) and whether this correlated with worse clinical outcome at discharge.


RESULTS
The M1a group had worse pre-Merci NIHSS (21 versus 14, P=0.004), worse discharge NIHSS (12 versus 4, P<0.001), longer hospital length of stay (11.5 versus 6.4 days, P=0.003), and higher rates of discharge mRS > or = 3 (OR 8.4, 95% CI 2.1 to 44.7) despite equivalent recanalization rates when compared to the M1b group. The M1a group had a higher rate of parenchymal hematomal HT (OR 6.7, 95% CI 1.02 to 183.3). Patients with such hematomal HT had higher rates of death or dependency discharge (100% versus 60%, OR=infinite).


CONCLUSIONS
Among patients with ICA and M1 occlusions, preintervention diffusion MRI evidence of advanced injury in the basal ganglia bodes worse dysfunction and disability at discharge, longer hospital stays, and higher rates of hemorrhage after intervention when compared to other diffusion patterns.
Loh
Yince
Y
Division of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA. yincer@yahoo.com
Towfighi
Amytis
A
Liebeskind
David S
DS
MacArthur
David L
DL
Vespa
Paul
P
Gonzalez
Nestor R
NR
Tateshima
Satoshi
S
Starkman
Sidney
S
Saver
Jeffrey L
JL
Shi
Zhong-Song
ZS
Jahan
Reza
R
Viñuela
Fernando
F
Duckwiler
Gary R
GR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020144:Basal Ganglia Cerebrovascular Disease / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D020767:Intracranial Thrombosis / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*