title: Preprocedural basal ganglionic infarction increases the risk of hemorrhagic transformation but not worse outcome following successful recanalization of acute middle cerebral artery occlusions.
abstract: OBJECTIVE
  We recently demonstrated that the preprocedural magnetic resonance imaging (MRI) pattern of deep middle cerebral artery (MCA) territory injury predicts poor prognosis. We postulate that the structures of the deep MCA field are particularly vulnerable to hemorrhagic transformation (HT) following reperfusion.
  
  
  METHODS
  We reviewed all cases of acute occlusions involving the M1 segment of the MCA with diffusion restriction of at least 50% of the deep MCA field on MRI (M1a pattern) that underwent endovascular therapy. We compared those with and without recanalization in regards to HT and disability on discharge.
  
  
  RESULTS
  Thirty-five patients met inclusion criteria. The recanalized M1a group (n=27) had higher rates of HT (67% vs. 25%, P=0.05) and a trend toward more parenchymal HT (37% vs. 0%, P=0.07) and symptomatic HT (22% vs. 0%, P=0.12) than those M1a patients who failed to recanalize (n=8). Clinical improvement in the National Institutes of Health Stroke Scale by discharge was better in the survivors of the recanalized group.
  
  
  CONCLUSIONS
  Among patients with the preintervention M1a MRI pattern of advanced basal ganglionic injury, successful recanalization predicts a higher risk of HT but better outcome.
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. yincer@yahoo.com
authors.forename: Yince
authors.initials: Y
authors.lastname: Loh
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Amytis
authors.initials: A
authors.lastname: Towfighi
authors.forename: Paul
authors.initials: P
authors.lastname: Vespa
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Gonzalez
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tateshima
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.forename: Zhong-Song
authors.initials: ZS
authors.lastname: Shi
authors.forename: Fernando
authors.initials: F
authors.lastname: Viñuela
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000098:blood supply / Q000473:pathology; D020144:Basal Ganglia Cerebrovascular Disease / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000473:pathology; D002548:Cerebral Revascularization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome