Baek Byung Hyun, Yoon Woong, Lee Yun Young, Park Ilwoo, Kim Seul Kee
Department of Radiology, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
Neuroradiology. 2019 Jan;61(1):89-96. doi: 10.1007/s00234-018-2126-x. Epub 2018 Nov 6.
Acute infarction confined to the basal ganglia (BG) is occasionally observed on baseline imaging before endovascular thrombectomy. This study aimed to investigate the impact of isolated BG infarction revealed on pretreatment DWI in a large cohort of patients with acute anterior circulation stroke who underwent thrombectomy.
We retrospectively analyzed clinical and DWI data from 328 patients who underwent thrombectomy for emergent occlusions of the intracranial internal carotid artery or the middle cerebral artery. Characteristics and treatment outcomes were compared between patients with isolated BG infarction and those with non-isolated BG infarction. Binary logistic regression analyses were performed to identify independent predictors of good outcome (90-day mRS 0-2).
Isolated BG infarction was found in 57 patients (17.4%). Patients with isolated BG infarction had a higher incidence of underlying severe intracranial atherosclerotic stenosis (21.1% vs. 10.7%, P = 0.032) than those with non-isolated BG infarction. Successful reperfusion occurred more frequently in patients with isolated BG infarction than those with non-isolated BG infarction (93% vs. 79%, odds ratio 3.529, 95% confidence interval 1.226-10.161, P = 0.014). On multivariate logistic regression analysis, independent predictors of good outcome were age, DWI-ASPECTS, and admission NIHSS score. There was no significant difference in the rate of good outcome between the two groups (54.4% vs. 42.8%, P = 0.110).
Isolated BG infarction on pretreatment DWI may predict successful reperfusion after endovascular thrombectomy in patients with acute anterior circulation stroke. In addition, our study suggested a novel finding that isolated BG infarction was more frequently associated with underlying severe ICAS than non-isolated BG infarction.
在血管内血栓切除术之前的基线影像学检查中偶尔会观察到局限于基底节区（BG）的急性梗死。本研究旨在调查在接受血栓切除术的大量急性前循环卒中患者队列中，术前弥散加权成像（DWI）显示的孤立性BG梗死的影响。
我们回顾性分析了328例因颅内颈内动脉或大脑中动脉急性闭塞而接受血栓切除术的患者的临床和DWI数据。比较了孤立性BG梗死患者和非孤立性BG梗死患者的特征及治疗结果。进行二元逻辑回归分析以确定良好预后（90天改良Rankin量表评分0 - 2分）的独立预测因素。
57例患者（17.4%）发现有孤立性BG梗死。与非孤立性BG梗死患者相比，孤立性BG梗死患者潜在严重颅内动脉粥样硬化狭窄的发生率更高（21.1%对10.7%，P = 0.032）。孤立性BG梗死患者成功再灌注的发生率高于非孤立性BG梗死患者（93%对79%，比值比3.529，95%置信区间1.226 - 10.161，P = 0.014）。在多变量逻辑回归分析中，良好预后的独立预测因素是年龄、DWI脑梗死范围评分（DWI-ASPECTS）和入院时美国国立卫生研究院卒中量表（NIHSS）评分。两组良好预后率无显著差异（54.4%对42.8%，P = 0.110）。
术前DWI显示的孤立性BG梗死可能预测急性前循环卒中患者血管内血栓切除术后的成功再灌注。此外，我们的研究提出了一个新发现，即与非孤立性BG梗死相比，孤立性BG梗死更常与潜在的严重颅内动脉粥样硬化（ICAS）相关。
