Basal Ganglionic Infarction Before Mechanical Thrombectomy Predicts Poor Outcome

Author:

Loh Yince1,Towfighi Amytis1,Liebeskind David S.1,MacArthur David L.1,Vespa Paul1,Gonzalez Nestor R.1,Tateshima Satoshi1,Starkman Sidney1,Saver Jeffrey L.1,Shi Zhong-Song1,Jahan Reza1,Viñuela Fernando1,Duckwiler Gary R.1

Affiliation:

1. From the Divisions of Neurosurgery (Y.L., D.L.M., P.V., N.R.G.) and Interventional Neuroradiology (Y.L., N.R.G., S.T., Z.-S.S., R.J., F.V., G.R.D.) and the Department of Neurology (D.S.L., S.S., J.L.S.), David Geffen School of Medicine at UCLA, Los Angeles, Calif; the Department of Neurology (A.T.), USC Comprehensive Stroke Center, Keck School of Medicine at USC, Heath Care Consultation Center II, Los Angeles, Calif; and the Neurovascular Service, Department of Medicine (Y.L.), Madigan Army Medical...

Abstract

Background and Purpose— 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 ≥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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

Reference33 articles.

1. MERCI 1

2. Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke

3. Kidwell CS Jahan R Starkman S Alger JR Guzy J McCullough-Hicks M Schaewe TJ Saver JL. MR and Recanalization of stroke clots using embolectomy (MR-RESCUE). Presented at the American Stroke Association International Stroke Conference Feb 18 2009;San Diego CA.

4. Beyond Mismatch

5. The variations of lenticulostriate arteries in the middle cerebral artery aneurysms

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3