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Predictors for basal ganglia viability after mechanical thrombectomy in proximal middle cerebral artery occlusion

      Highlights

      • M1 segment occlusion covering the lenticulostriate arteries (LSA) is mostly associated with basal ganglia (BG) infarction.
      • Ischemic tolerance of BG is limited due to supposed lack of collateral supply.
      • However, in a substantial number of patients basal ganglia viability can be observed despite prolonged occlusion of the LSA.
      • Predictors for basal ganglia viability were CT collateralization score and rCBV ratio values
      • This findings might indicate a collateralization of the BG that is not depictable by radiological imaging modalities

      Abstract

      Background/purpose

      In acute proximal middle cerebral artery (MCA) occlusion covering the lenticulostriate arteries (LSA), ischemic tolerance of basal ganglia is limited due to supposed lack of collateral supply. However, in several patients, basal ganglia (BG) infarction was absent after successful mechanical thrombectomy (MTE). Purpose of our study was to evaluate predictors for BG viability in stroke patients despite prolonged MCA mainstem occlusion.

      Material/methods

      We retrospectively reviewed all stroke patients from our local registry with MCA mainstem occlusion after mechanical thrombectomy between November 2009 and October 2016. All patients underwent non-enhanced post-interventional cranial CT imaging (NCCT) and were classified according to 6 patterns of BG viability: complete: putamen (P) and globus pallidus (GP); partial: P or GP, and combination of complete or partial BG and/or adjacent white matter/cortical (WMC) viability. We compared viability patterns with respect to pre-interventional stroke imaging including NCCT, CT-angiography (CTA), CT perfusion (CTP); demographics, pre- and intra-procedural data and occurrence of post-procedural intracerebral hematoma (ICH). CTP imaging of the affected and contralateral BG-territories were obtained separately and CTA-collateral score (CS) was assessed.

      Results

      A significant correlation between higher collateral score and viability of GP (OR = 1.949; p = .011), P (OR = 2.039, p = .011), and the combination of GP, P and WMC (OR = 2.767, p = .007) was revealed. Higher relative CBV ratio (rCBVR) was significantly associated with viability of the pattern GP + WMC (univariate: OR = 3.160, p = .014; multivariate: OR = 6.058; p = .021).

      Conclusion

      CTA collateral score and rCBVR were predictive for BG viability in stroke patients after successful MTE in prolonged complete MCA-mainstem and LSA occlusion.

      Keywords

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