title: Basal ganglionic infarction before mechanical thrombectomy predicts poor outcome.
abstract: 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.
authors: Division of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA. yincer@yahoo.com
authors: Yince
authors: Y
authors: Loh
authors: Amytis
authors: A
authors: Towfighi
authors: David S
authors: DS
authors: Liebeskind
authors: David L
authors: DL
authors: MacArthur
authors: Paul
authors: P
authors: Vespa
authors: Nestor R
authors: NR
authors: Gonzalez
authors: Satoshi
authors: S
authors: Tateshima
authors: Sidney
authors: S
authors: Starkman
authors: Jeffrey L
authors: JL
authors: Saver
authors: Zhong-Song
authors: ZS
authors: Shi
authors: Reza
authors: R
authors: Jahan
authors: Fernando
authors: F
authors: Viñuela
authors: Gary R
authors: GR
authors: Duckwiler
mesh_terms: 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*