Basal Ganglionic Infarction Before Mechanical Thrombectomy Predicts Poor Outcome

Use of mechanical thrombectomy for acute cerebrovascular occlusions is increasing. Preintervention MRI patterns may be helpful in predicting prognosis. We reviewed all Merci thrombectomy cases of either terminal ICA or M1 occlusions and classified them according to diffusion MRI patterns of (1) comp...

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Published in:	Stroke (1970) Vol. 40; no. 10; pp. 3315 - 3320
Main Authors:	LOH, Yince, TOWFIGHI, Amytis, JAHAN, Reza, VINUELA, Fernando, DUCKWILER, Gary R, LIEBESKIND, David S, MACARTHUR, David L, VESPA, Paul, GONZALEZ, Nestor R, TATESHIMA, Satoshi, STARKMAN, Sidney, SAVER, Jeffrey L, SHI, Zhong-Song
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 01-10-2009
Subjects:	Adult Aged Aged, 80 and over Basal Ganglia Cerebrovascular Disease - pathology Basal Ganglia Cerebrovascular Disease - physiopathology Basal Ganglia Cerebrovascular Disease - surgery Biological and medical sciences Cerebral Hemorrhage - epidemiology Cerebral Hemorrhage - pathology Cerebral Hemorrhage - physiopathology Cerebral Infarction - pathology Cerebral Infarction - physiopathology Cerebral Infarction - surgery Diffusion Magnetic Resonance Imaging - methods Drug toxicity and drugs side effects treatment Female Humans Infarction, Middle Cerebral Artery - pathology Infarction, Middle Cerebral Artery - physiopathology Infarction, Middle Cerebral Artery - surgery Intracranial Thrombosis - pathology Intracranial Thrombosis - physiopathology Intracranial Thrombosis - surgery Male Medical sciences Middle Aged Middle Cerebral Artery - pathology Middle Cerebral Artery - physiopathology Middle Cerebral Artery - surgery Miscellaneous (drug allergy, mutagens, teratogens...) Neurology Outcome Assessment (Health Care) - methods Patient Selection Pharmacology. Drug treatments Postoperative Hemorrhage - epidemiology Postoperative Hemorrhage - pathology Postoperative Hemorrhage - physiopathology Predictive Value of Tests Preoperative Care - methods Prognosis Retrospective Studies Severity of Illness Index Thrombectomy - adverse effects Thrombectomy - methods Thrombectomy - mortality Vascular diseases and vascular malformations of the nervous system Stroke Nervous system diseases Prognosis basal ganglia Infarct thrombectomy Cardiovascular disease Basal ganglion Merci Hemorrhage Cerebral disorder Vascular disease Central nervous system disease Cerebrovascular disease
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Summary:	Use of mechanical thrombectomy for acute cerebrovascular occlusions is increasing. Preintervention MRI patterns may be helpful in predicting prognosis. 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. 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). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0039-2499 1524-4628
DOI:	10.1161/strokeaha.109.551705