Basal ganglionic infarction before mechanical thrombectomy predicts poor outcome.

Area of Science:

• Neurology
• Radiology
• Interventional Neurology

Background:

• Mechanical thrombectomy is increasingly used for acute cerebrovascular occlusions.
• Preintervention imaging, particularly MRI, may offer prognostic value.

Purpose of the Study:

• To evaluate the predictive value of diffusion MRI patterns in patients with internal carotid artery (ICA) or M1 occlusions undergoing mechanical thrombectomy.
• To correlate MRI findings with clinical outcomes, recanalization rates, and hemorrhagic transformation.

Main Methods:

• Retrospective review of Merci thrombectomy cases with ICA or M1 occlusions.
• Classification of diffusion MRI patterns into completed basal ganglia infarct (M1a) and relative sparing of deep MCA field (M1b).
• Comparison of clinical outcomes, recanalization, hospital stay, and disability between M1a and M1b groups.

Main Results:

• The M1a group showed significantly worse pre- and post-intervention NIHSS scores, longer hospital stays, and higher rates of discharge disability (mRS > or = 3) compared to the M1b group.
• Recanalization rates were equivalent between groups.
• Advanced basal ganglia infarct (M1a) was associated with a higher rate of parenchymal hematomal hemorrhage transformation (HT), which correlated with death or dependency at discharge.

Conclusions:

• Preintervention diffusion MRI showing advanced basal ganglia injury in acute stroke patients with ICA/M1 occlusions predicts worse functional outcomes and higher hemorrhage risk after mechanical thrombectomy.
• Diffusion MRI patterns can aid in prognostication and patient selection for intervention.