Abstract W MP21: Contrast Staining on Ct After Endovascular Treatment for Acute Ischemic Stroke: Association With Worse Outcomes

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Esteban Cheng-Ching ◽  
Muhammad S Hussain ◽  
Gabor Toth ◽  
Nancy Obuchowski ◽  
Shumei Man ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Group Versus ◽  
Hemorrhagic Transformation ◽  
Chi Square ◽  
Vessel Occlusion ◽  
Post Procedure ◽  
Imaging Characteristics ◽  
Clinical Consequences ◽  
Brain Ct Scan

Introduction: Parenchymal contrast staining may appear on computerized tomography after intra-arterial therapy for acute ischemic stroke. This finding may not be associated with hemorrhagic transformation and has been reported to be transient. However, the incidence, associations and clinical consequences have not been well described. Methods: We reviewed a prospectively collected database of acute ischemic stroke patients admitted between January of 2012 and April of 2013. We included patients with acute ischemic stroke and large vessel occlusion who underwent endovascular therapy. Demographic, clinical and imaging characteristics were assessed. Post-procedure brain CTs were reviewed for contrast staining and ASPECTS score. Discharge and 30-day follow up data were compared using Wilcoxon two-sample tests and chi square tests. Results: 59 patients (34 (57.6%) female, mean age: 66.7 years;) were included in the analysis. Twenty two patients (37.3%) had contrast staining on post-procedure brain CT scan. Of this group, the initial median NIHSS was 16.5 and initial median ASPECTS score was 7 (compared to initial median NIHSS of 15 and median ASPECTS of 9 in those without contrast staining) (p=0.297 and 0.166, respectively). Recanalization rates were similar for both groups (82% vs. 83%, p=0.882). Upon discharge, the group of patients with post-procedure CT with contrast staining had significantly higher NIHSS (median of 15) and lower CT ASPECTS score (median of 6), (compared to NIHSS of 7 and CT ASPECTS of 8 in those without contrast staining) (p=0.025 and 0.017). Patients who had contrast staining tended to be more likely to have a hemorrhagic transformation of the ischemic infarct area (59.1% versus 36.1%, p=0.088) with rates of PH1 being 18.2% (versus 8.1%, p=0.407) and PH2 being 22.7% (versus 5.4%, p=0.090). The data also suggest a difference in the 30-day NIHSS (10 in the contrast staining group versus 4, p=0.092) and 30-day MRS (4 in the contrast staining group versus 3, p=0.107). Conclusion: The presence of contrast staining on CT obtained after intra-arterial therapy for acute ischemic stroke may be associated with worse imaging and clinical outcomes, including hemorrhagic transformation and worse neurologic deficits upon discharge and at 30 days.

Abstract 177: Absent Collateral Flow on CT Angiogram Predicts Acute Hemorrhagic Transformation in Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Richard Burgess ◽  
Esteban Cheng Ching ◽  
Delora Wisco ◽  
Shumei Man ◽  
Ken Uchino ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Hemorrhagic Transformation ◽  
Collateral Flow ◽  
Stroke Patients ◽  
Conventional Angiography ◽  
Vessel Occlusion ◽  
Post Procedure ◽  
Ct Angiogram

Background: In patients with a large vessel occlusion, the degree of collateral vascular supply to an ischemic territory has been shown to be a predictor of stroke outcome. Prior studies have focused on the correlation between collateral flow measured on conventional digital subtraction angiography and outcome measures, including the presence of hemorrhagic conversion. CT/CTA is more widely available and more quickly accomplished than MR or conventional angiography. In this work we demonstrate that the absence of CT angiographic collaterals predicts hemorrhage transformation in acute ischemic stroke patients that have persistent vessel occlusion. Methods: Retrospective review of patient data from a prospectively acquired database identified acute ischemic stroke patients who underwent CT angiography followed by cerebral angiography, and post procedure non-contrast CT scans. Blinded evaluators independently assessed CT angiogram collaterals, angiographic TICI scores, and the presence and severity of post procedure hemorrhagic transformation. Fishers exact test was used to compare proportions between groups. Results: 146 patients were included. The mean age was 67. The median NIHSS was 15.5 (range 0-32). 34% of patients had any type of hemorrhagic conversion. Of patients with no collaterals on CT angiography, 63% had hemorrhagic conversion versus 23%, 33%, and 38% for patients with grades 1, 2, and 3 collaterals (p<0.05 for comparisons). Patients with TICI scores of 0 or 1 and no CTA collaterals all had hemorrhagic transformation. Conclusion: The absence of collateral flow on CT angiography in patients without recanalization strongly predicts the acute development of hemorrhagic conversion.

Abstract WMP17: Computerized Tomography Perfusion to Characterize Lack of Clinical Improvement After Recanalization in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alvaro Garcia-Tornel ◽  
Marta Olive-Gadea ◽  
Marc Ribo ◽  
David Rodriguez-Luna ◽  
Jorge Pagola ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Infarct Volume ◽  
Significant Proportion ◽  
Hemorrhagic Transformation ◽  
Vessel Occlusion ◽  
Clinical Recovery ◽  
Good Functional Outcome ◽  
Significant Difference

A significant proportion of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) present poor functional outcome despite recanalization. We aim to investigate computed tomography perfusion (CTP) patterns after EVT and their association with outcome Methods: Prospective study of anterior large vessel occlusion AIS patients who achieved complete recanalization (defined as modified Thrombolysis in Cerebral Ischemia (TICI) 2b - 3) after EVT. CTP was performed within 30 minutes post-EVT recanalization (POST-CTP): hypoperfusion was defined as volume of time to maximal arrival of contrast (Tmax) delay ≥6 seconds in the affected territory. Hyperperfusion was defined as visual increase in cerebral blood flow (CBF) and volume (CBV) with advanced Tmax compared with the unaffected hemisphere. Dramatic clinical recovery (DCR) was defined as a decrease of ≥8 points in NIHSS score at 24h or NIHSS≤2 and good functional outcome by mRS ≤2 at 3 months. Results: One-hundred and forty-one patients were included. 49 (34.7%) patients did not have any perfusion abnormality on POST-CTP, 60 (42.5%) showed hypoperfusion (median volume Tmax≥6s 17.5cc, IQR 6-45cc) and 32 (22.8%) hyperperfusion. DCR appeared in 56% of patients and good functional outcome in 55.3%. Post-EVT hypoperfusion was related with worse final TICI, and associated worse early clinical evolution, larger final infarct volume (p<0.01 for all) and was an independent predictor of functional outcome (OR 0.98, CI 0.97-0.99, p=0.01). Furthermore, POST-CTP identified patients with delayed improvement: in patients without DCR (n=62, 44%), there was a significant difference in post-EVT hypoperfusion volume according to functional outcome (hypoperfusion volume of 2cc in good outcome vs 11cc in poor outcome, OR 0.97 CI 0.93-0.99, p=0.04), adjusted by confounding factors. Hyperperfusion was not associated with worse outcome (p=0.45) nor symptomatic hemorrhagic transformation (p=0.55). Conclusion: Hypoperfusion volume after EVT is an accurate predictor of functional outcome. In patients without dramatic clinical recovery, hypoperfusion predicts good functional outcome and defines a “stunned-brain” pattern. POST-CTP may help to select EVT patients for additional therapies.

Abstract T P26: Combining Clinical and Imaging Data to Develop a Highly Predictive Model of Outcomes in the MR RESCUE Trial

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Chelsea S Kidwell ◽  
Reza Jahan ◽  
Jeffrey Gornbein ◽  
Jeffry R Alger ◽  
Val Nenov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Patient Characteristics ◽  
Hemorrhagic Transformation ◽  
Imaging Data ◽  
Vascular Events ◽  
Vessel Occlusion ◽  
Intermediate Variables ◽  
Core Volume

Background: Identifying patient characteristics that predict outcomes in acute ischemic stroke may assist in triaging those who are candidates for endovascular therapies. We sought to identify predictors of outcome in the overall Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohort and compare results to the previously validated Totaled Health Risks in Vascular Events (THRIVE) score. Methods: MR RESCUE randomized 118 acute ischemic stroke patients with multimodal imaging to embolectomy or standard care within 8 hours of onset. For this analysis, we investigated 17 baseline variables (e.g. age, predicted core volume, time to enrollment) and 8 intermediate variables (e.g. hemorrhagic transformation, day 7 recanalization, final infarct volume) with the potential to impact outcomes (day 90 mRS). The baseline variables were analyzed employing bivariate and multivariate methods (random forest and logistic regression). Two models were developed, one including only significant baseline variables, and the second also incorporating significant intermediate variables. Results: A multivariate model (Table) employing only baseline covariates achieved an overall accuracy (C statistic) of 85% in predicting poor outcome (day 90 mRS 3-6) compared to 80.5% for the THRIVE score. A second model (Table) adding significant intermediate variables achieved 89% accuracy in predicting day 90 mRS. Conclusions: In the MR RESCUE trial, advanced imaging variables, including predicted core volume and site of vessel occlusion, contributed to a highly accurate multivariable model of outcome. In the development phase, this model achieved higher accuracy than the THRIVE score. Future studies are needed to validate this model in an independent cohort.

scholarly journals Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review

2016 ◽  
Vol 9 (6) ◽  
pp. 529-534 ◽  
Author(s):  
Waleed Brinjikji ◽  
Sharon Duffy ◽  
Anthony Burrows ◽  
Werner Hacke ◽  
David Liebeskind ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Strategies ◽  
Hounsfield Unit ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Stroke Etiology ◽  
Imaging Characteristics ◽  
Significant Difference

Background and purposeStudying the imaging and histopathologic characteristics of thrombi in ischemic stroke could provide insights into stroke etiology and ideal treatment strategies. We conducted a systematic review of imaging and histologic characteristics of thrombi in acute ischemic stroke.Materials and methodsWe identified all studies published between January 2005 and December 2015 that reported findings related to histologic and/or imaging characteristics of thrombi in acute ischemic stroke secondary to large vessel occlusion. The five outcomes examined in this study were (1) association between histologic composition of thrombi and stroke etiology; (2) association between histologic composition of thrombi and angiographic outcomes; (3) association between thrombi imaging and histologic characteristics; (4) association between thrombi imaging characteristics and angiographic outcomes; and (5) association between imaging characteristics of thrombi and stroke etiology. A meta-analysis was performed using a random effects model.ResultsThere was no significant difference in the proportion of red blood cell (RBC)-rich thrombi between cardioembolic and large artery atherosclerosis etiologies (OR 1.62, 95% CI 0.1 to 28.0, p=0.63). Patients with a hyperdense artery sign had a higher odds of having RBC-rich thrombi than those without a hyperdense artery sign (OR 9.0, 95% CI 2.6 to 31.2, p<0.01). Patients with a good angiographic outcome had a mean thrombus Hounsfield unit (HU) of 55.1±3.1 compared with a mean HU of 48.4±1.9 for patients with a poor angiographic outcome (mean standard difference 6.5, 95% CI 2.7 to 10.2, p<0.001). There was no association between imaging characteristics and stroke etiology (OR 1.13, 95% CI 0.32 to 4.00, p=0.85).ConclusionsThe hyperdense artery sign is associated with RBC-rich thrombi and improved recanalization rates. However, there was no association between the histopathological characteristics of thrombi and stroke etiology and angiographic outcomes.

scholarly journals MRI Characteristics in Acute Ischemic Stroke Patients with Preceding Direct Oral Anticoagulant Therapy as compared to Vitamin K Antagonists

2020 ◽  
Author(s):  
Thomas Meinel ◽  
Johannes Kaesmacher ◽  
Jan Gralla ◽  
David Julian Seiffge ◽  
Elias Auer ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Hemorrhagic Transformation ◽  
Ischemic Lesion ◽  
Lesion Diameter ◽  
Imaging Characteristics ◽  
Therapeutic Anticoagulation

Abstract Background : Despite the utility of neuroimaging in the diagnostic and therapeutic management of patients with acute ischemic stroke (AIS), imaging characteristics in patients with preceding direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) have hardly been described. We aimed to determine presence of large vessel occlusion (LVO), thrombus length, infarction diameter, and occurrence of hemorrhagic transformation in AIS patients with preceding DOAC as compared to VKA therapy. Methods : Using a prospectively collected cohort of AIS patients, we performed univariate and multivariable regression analyses regarding imaging outcomes. Additionally, we provide a sensitivity analysis for the subgroup of patients with confirmed therapeutic anticoagulation. Results : We included AIS in patients with preceding DOAC (N=75) and VKA (N=61) therapy, median age 79 (IQR 70 – 83), 39% female. Presence of any LVO between DOAC and VKA patients (29.3% versus 37.7%, P=0.361), and target LVO for endovascular therapy (26.7% versus 27.9%, P=1.0) was equal with a similar occlusion pattern. DOAC as compared to VKA were associated with a similar rate of target LVO for EVT (aOR 0.835, 95% CI 0.368 – 1.898). The presence of multiple lesions and characteristics of the thrombus were similar in DOAC and VKA patients. Acute ischemic lesion diameter in real world patients was equal in patients taking DOAC as compared to VKA. Lesion diameter in VKA patients (median 13 mm, IQR 6 – 26 versus median 20 mm, IQR 7 – 36, P=0.001), but not DOAC patients was smaller in the setting of confirmed therapeutic VKA. The frequency of radiological hemorrhagic transformation and symptomatic intracranial hemorrhage in OAC patients was low. Sensitivity analysis considering only patients with confirmed therapeutic anticoagulation did not change any of the results. Conclusion : Preceding DOAC treatment showed equal rates of LVO and infarct size as compared to VKA in AIS patients. This study adds to the knowledge of imaging findings in AIS patients with preceding anticoagulation.

Abstract WP129: MRI and Non Contrast CT Clot Imaging for Successful Large Vessel Clot Resolution of Posterior Circulation Ischemic Strokes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Siddhart Mehta ◽  
Spozhmy Panezai ◽  
Ashish Kulhari ◽  
Audrey Z Arango ◽  
Laura Suhan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Posterior Circulation ◽  
Large Vessel ◽  
Vessel Occlusion ◽  
Imaging Characteristics ◽  
Ct Angiogram ◽  
Ct Head ◽  
Contrast Ct

Background: Thrombi retrieved from patients with an acute ischemic stroke with Large Vessel Occlusion (LVO) and correlation with hyperdense vessel sign seen on non contrast CT and blooming artifact seen on gradient-echo(GRE) MRI have given relevant insights into the pathophysiology of thrombotic lesions (RBC-dominant vs Fibrin-dominant). This may facilitate the development of safer noninvasive reperfusion treatment approaches. Our goal was to evaluate the benefit of anticoagulation for posterior circulation strokes based on imaging characteristics in patients where endovascular therapy was not justified. Method: Comprehensive prospective evaluation of patients who presented with posterior circulation LVOs at a community based, university affiliated comprehensive stroke center during one year period (January 2015-December 2015) was done. The clot characteristics on thin-sliced reformatted CT, CT Angiogram and GRE MRI were noted. The clot size and characteristics were followed by sequential imaging while the patients were on anticoagulation for presumed embolic thrombus. Results: Total 749 patients presented with acute ischemic stroke during the pre-specified time period. Of those 78 were posterior circulation strokes; of which, 7 had LVO and 4 underwent endovascular treatment. Endovascular therapy was not justified in 3 patients due to clinically stable exam. These patients were thought to have embolic etiology of stroke and therefore were started on anticoagulation. Group A (RBC-dominant thrombus; n=2) mean clot length was 15.5mm, measured on CT, CTA, MRI. GRE MRI showed blooming artifact around the area of thrombus. Thrombus resolved on repeat CTA at 48-72hours. Group B (Fibrin-dominant; n=1) 5.5mm clot was visualized only on CTA (nothing on CT head and MRI) and it persisted on repeat CTA at 48-72hours. Mean initial NIHSS was 2 (SD +/- 1 ). Mean discharge NIHSS was 0.33 (SD +/- 0.577). Mean discharge mRS was 0.67 (SD +/- 0.57). Conclusion: Hyperdense sign on reformatted thin-sliced CT head and blooming artifact on GRE MRI brain in patients with LVO can be used to characterize the composition of thrombus, which could be helpful in deciding medical therapy. A larger prospective randomized trial is needed to corroborate our findings.

scholarly journals Prospective, Multicenter, Single-Arm Study of Mechanical Thrombectomy Using Solitaire Flow Restoration in Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2802-2807 ◽  
Author(s):  
Vitor M. Pereira ◽  
Jan Gralla ◽  
Antoni Davalos ◽  
Alain Bonafé ◽  
Carlos Castaño ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Hemorrhagic Transformation ◽  
Anterior Circulation ◽  
Unique Identifier ◽  
Vessel Occlusion ◽  
Clinical Trial Registration ◽  
End Point ◽  
Flow Restoration

Background and Purpose— Mechanical thrombectomy using stent retriever devices have been advocated to increase revascularization in intracranial vessel occlusion. We present the results of a large prospective study on the use of the Solitaire Flow Restoration in patients with acute ischemic stroke. Methods— Solitaire Flow Restoration Thrombectomy for Acute Revascularization was an international, multicenter, prospective, single-arm study of Solitaire Flow Restoration thrombectomy in patients with large vessel anterior circulation strokes treated within 8 hours of symptom onset. Strict criteria for site selection were applied. The primary end point was the revascularization rate (thrombolysis in cerebral infarction ≥2b) of the occluded vessel as determined by an independent core laboratory. The secondary end point was the rate of good functional outcome (defined as 90-day modified Rankin scale, 0–2). Results— A total of 202 patients were enrolled across 14 comprehensive stroke centers in Europe, Canada, and Australia. The median age was 72 years, 60% were female patients. The median National Institute of Health Stroke Scale was 17. Most proximal intracranial occlusion was the internal carotid artery in 18%, and the middle cerebral artery in 82%. Successful revascularization was achieved in 79.2% of patients. Device and procedure-related severe adverse events were found in 7.4%. Favorable neurological outcome was found in 57.9%. The mortality rate was 6.9%. Any intracranial hemorrhagic transformation was found in 18.8% of patients, 1.5% were symptomatic. Conclusions— In this single-arm study, treatment with the Solitaire Flow Restoration device in intracranial anterior circulation occlusions results in high rates of revascularization, low risk of clinically relevant procedural complications, and good clinical outcomes in combination with low mortality at 90 days. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01327989.

Drivers of variation in 90-day episode payments after mechanical thrombectomy for acute ischemic stroke

2020 ◽  
pp. neurintsurg-2020-016389
Author(s):  
Badih J Daou ◽  
Monica L Yost ◽  
John D Syrjamaki ◽  
Kelsey J Fearer ◽  
Sravanthi Koduri ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Claims Data ◽  
Standard Of Care ◽  
Post Discharge ◽  
Chi Square ◽  
Vessel Occlusion ◽  
Discharge Care ◽  
Insured Patients

BackgroundAlthough mechanical thrombectomy for acute ischemic stroke from a large vessel occlusion is now the standard of care, little is known about cost variations in stroke patients following thrombectomy and factors that influence these variations.MethodsWe evaluated claims data for 2016 to 2018 for thrombectomy-performing hospitals within Michigan through a registry that includes detailed episode payment information for both Medicare and privately insured patients. We aimed to analyze price-standardized and risk-adjusted 90-day episode payments in patients who underwent thrombectomy. Hospitals were grouped into three payment terciles for comparison. Statistical analysis was carried out using unpaired t-test, Chi-square, and ANOVA tests.Results1076 thrombectomy cases treated at 16 centers were analyzed. The average 90-day episode payment by hospital ranged from $53 046 to $81,767, with a mean of $65 357. A $20 467 difference (35.1%) existed between the high and low payment hospital terciles (P<0.0001), highlighting a significant payment variation across hospital terciles. The primary drivers of payment variation were related to post-discharge care which accounted for 38% of the payment variation (P=0.0058, inter-tercile range $11,977–$19,703) and readmissions accounting for 26% (P=0.016, inter-tercile range $3,315–$7,992). This was followed by professional payments representing 20% of the variation (P<0.0001, inter-tercile range $7525–$9,922), while index hospitalization payment was responsible for only 16% of the 90-day episode payment variation (P=0.10, inter-tercile range $35,432–$41,099).ConclusionsThere is a wide variation in 90-day episode payments for patients undergoing mechanical thrombectomy across centers. The main drivers of payment variation are related to differences in post-discharge care and readmissions.

Impact of basal ganglia damage after successful endovascular recanalization for acute ischemic stroke involving lenticulostriate arteries

2020 ◽  
Vol 132 (6) ◽  
pp. 1880-1888
Author(s):  
Nobutaka Horie ◽  
Yoichi Morofuji ◽  
Yusuke Iki ◽  
Eisaku Sadakata ◽  
Tadashi Kanamoto ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basal Ganglia ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Lentiform Nucleus ◽  
Lenticulostriate Arteries ◽  
Endovascular Recanalization

OBJECTIVERegional ischemic vulnerability of the brain reportedly differs between the cortex and basal ganglia and has been poorly assessed in the setting of endovascular mechanical thrombectomy. This study was conducted to determine the fate of an ischemic basal ganglia and its contribution to the clinical outcome after successful endovascular recanalization for acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries.METHODSClinical and radiological findings were retrospectively analyzed in consecutive patients with acute ischemic stroke characterized by large vessel occlusion involving the lenticulostriate arteries. Mechanical thrombectomy was performed in all patients using a stent retriever. The fate of ischemic basal ganglia based on location (lentiform nucleus, caudate nucleus, and internal capsule) and insular cortex was assessed according to the Alberta Stroke Programme Early CT Score (ASPECTS).RESULTSOf 170 patients with large intracranial vessel occlusion who achieved successful endovascular recanalization, defined as a thrombolysis in cerebral infarction grade of ≥ 2B, involvement of the lenticulostriate arteries was seen in 55 patients (internal carotid artery, n = 35; proximal middle cerebral artery, n = 20). Preoperative infarction was detected in the lentiform nucleus (66.7%), internal capsule (11.1%), and caudate nucleus (33.3%), all of which showed secondary advancement despite successful recanalization (85.4%, 27.3%, and 54.5%, respectively; p < 0.05). Lenticulostriate arteries with a lateral proximal and/or medial proximal origin significantly affected the development of mature infarction in the lentiform nucleus. Postoperative hemorrhagic transformation was detected in 25 of 55 patients, mostly in the lentiform nucleus. Involvement of insular ribbon infarction was significantly high in patients with hemorrhagic transformation in the basal ganglia. Age, initial National Institutes of Health Stroke Scale (NIHSS) score, initial ASPECTS, postoperative ASPECTS, postoperative infarction in the insular ribbon, and lesions in the middle cerebral artery area (M1–M6) were significantly different between patients with good and poor modified Rankin Scale scores. Interestingly, no differences were detected in postoperative infarction or hemorrhagic transformation in the basal ganglia. Multivariate analysis showed that only age (p = 0.02, OR 0.88) and the initial NIHSS score (p = 0.01, OR 0.86) independently affected favorable clinical outcomes.CONCLUSIONSThe basal ganglia are vulnerable and readily develop secondary infarction and hemorrhagic transformation despite successful recanalization. However, this does not have a significant impact on the clinical outcome of acute ischemic stroke with large vessel occlusion involving the lenticulostriate arteries.

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