Isolated Striatocapsular Infarcts after Endovascular Treatment of Acute Proximal Middle Cerebral Artery Occlusions: Prevalence, Enabling Factors, and Clinical Outcome

Abstract

BackgroundStriatocapsular infarcts (SCIs) are defined as large subcortical infarcts involving the territory of more than one lenticulostriate artery. SCI without concomitant ischemia in the more distal middle cerebral artery (MCA) territory [isolated SCI (iSCI)] has been described as a rare infarct pattern. The purpose of this study was to assess the prevalence of iSCI in patients treated with endovascular thrombectomy (ET), to evaluate baseline and procedural parameters associated with this condition, and to describe the clinical course of iSCI patients.MethodsA retrospective analysis of 206 consecutive patients with an isolated MCA occlusion involving the lenticulostriate arteries and treated with ET was performed. Baseline patient and procedural characteristics and ischemic involvement of the striatocapsular and distal MCA territory [iSCI, as opposed to non-isolated SCI (niSCI)] were analyzed using multivariate logistic regression models. Prevalence of iSCI was assessed, and clinical course was determined with the rates of substantial neurological improvement and good functional short- and mid-term outcome (discharge/day 90 Modified Rankin Scale ≤2).ResultsiSCI was detected in 53 patients (25.7%), and niSCI was detected in 153 patients (74.3%). Successful reperfusion [thrombolysis in cerebral infarction (TICI) 2b/3] [adjusted odds ration (aOR) 8.730, 95% confidence interval (95% CI) 1.069–71.308] and good collaterals (aOR 2.100, 95% CI 1.119–3.944) were associated with iSCI. In successfully reperfused patients, TICI 3 was found to be an additional factor associated with iSCI (aOR 5.282, 1.759–15.859). Patients with iSCI had higher rates of substantial neurological improvement (71.7 vs. 37.9%, p < 0.001) and higher rates of good functional short- and mid-term outcome (58.3 vs. 23.7%, p < 0.001 and 71.4 vs. 41.7%, p < 0.001). However, while iSCI patients, in general, had a more favorable outcome, considerable heterogeneity in outcome was observed.ConclusionHigh rates of successful reperfusion (TICI 2b/3) and in particular, complete reperfusion (TICI 3) are associated with iSCIs. The high prevalence of iSCI in successfully reperfused patients with good collaterals corroborates previous concepts of iSCI pathogenesis. iSCI, once considered a rare pattern of cerebral ischemia, is likely to become more prevalent with increases in endovascular stroke therapy. This may have implications for patient rehabilitation and pathophysiological analyses of ischemic damage confined to subcortical regions of the MCA territory.

Dysphagia assessment in ischemic stroke after mechanical thrombectomy: When and how?

“…Hence, patients experience less neurological sequelae, as most or all parts of the eloquent neocortex are spared. Thus, the emergence of PSD is most likely due to affection of the subcortical swallowing network, of which the basal ganglia are part ( 40 , 41 ). The basal ganglia functionally connect the cerebral cortex and the thalamus, gating sensory input for motor control in deglutition.…”

“…In this context, insult to the brain before EVT might bear potential for lingering dysphagic symptoms. Infarction in the basal ganglia or internal capsule is more commonly observed in the setting of highly effective reperfusion therapy ( 18 , 41 ). As those brain regions play a vital role in the subcortical swallowing network recovery, they might have an impact on dysphagia prevalence and recovery.…”

Basal Ganglia versus Peripheral Infarcts: Predictive Value of Early Fiber Alterations

“…Both the interpretation and the limitations of the BGI analysis raise the challenge to further examine BGIs, their clinical presentation, and their pathophysiologic role in future studies, because the BGI entity presents with a wide interindividual variability and heterogeneity. 39 A limitation of the present study is that only common clinical parameters such as the NIHSS score, motor subindex scores, and the mRS were collected, but a large collective of almost all treated patients at a single comprehensive stroke center was included. These clinical parameters are assessed in the clinical routine for all patients independent of their condition or compliance, avoiding bias within the study cohort.…”

Movement disorders following mechanical thrombectomy resulting in ischemic lesions of the basal ganglia: An emerging clinical entity

“…Such ischemic lesions can present as a model of relatively selective damage of the BG. Effective MT normally cannot avert the lenticulate infarction, regardless of the recanalization achieved [17], not infrequently producing an isolated ischemic lesion of the BG [16].…”