Clinical Outcomes in Basal Ganglia Strokes Treated With Mechanical Thrombectomy

Background: Basal ganglia infarcts are thought to carry worse clinical outcomes compared with other infarct patterns. This study aimed to investigate whether pretreatment topographic infarct patterns, including complete basal ganglia involvement versus other infarct patterns, can help predict mechanical thrombectomy outcomes.

Methods: This was a review of a prospectively collected database of consecutive mechanical thrombectomy patients with anterior circulation large vessel occlusion strokes between January 2014 and November 2018. Patients were categorized into total basal ganglia (TBG) strokes (infarcts affecting both caudate and lentiform nuclei) and other infarct patterns. Infarct location was assessed on preprocedure noncontrast CT using automated software (e-ASPECTS).

Results: Of 1011 patients analyzed, 234 (23.12%) had TBG strokes. They were younger, had higher NIHSS, lower e-ASPECTS, and lower systolic blood pressure. There were no differences in 90-day functional outcomes (mRS ≤2: TBG 44.6% vs other 50.1%; P=0.14), but TBG strokes had significantly higher rates of parenchymal hematomas (15.4% vs 8.2%; P=0.001; adjusted OR 2.57).

Conclusions: Despite increased rates of hemorrhagic transformation, ganglionic infarcts carry similar functional outcomes after mechanical thrombectomy compared with other stroke patterns.