on August 6, 2009
Published online before print August 6, 2009, doi: 10.1161/STROKEAHA.109.551705
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on March 7, 2009
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 Center, Tacoma, Wash. * To whom correspondence should be addressed. E-mail: yincer{at}yahoo.com.
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 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.
Revised on June 9, 2009
Accepted on June 17, 2009
Basal Ganglionic Infarction Before Mechanical Thrombectomy Predicts Poor Outcome
Yince Loh MD*;
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).
Key words: Merci • thrombectomy • hemorrhage • basal ganglia