Impact of basal ganglia damage after successful endovascular recanalization for acute ischemic stroke involving lenticulostriate arteries
Impact of basal ganglia damage after successful endovascular recanalization for acute ischemic stroke involving lenticulostriate arteries
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DOI：
10.3171/2019.3.jns182909
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发表时间：
2020-06-01
影响因子：
4.1
通讯作者：
Matsuo, Takayuki
中科院分区：
文献类型：
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作者：
Horie, Nobutaka;Morofuji, Yoichi;Matsuo, Takayuki
目的：据报道，大脑皮层和基底神经节的局部缺血易损性不同，在血管内机械血栓切除术中评估不佳。本研究旨在确定缺血性基底神经节的命运及其对急性缺血性卒中血管内再通后临床结局的贡献，急性缺血性卒中伴大血管闭塞，涉及acumulostriate arteries.METHODS的临床和影像学结果进行了回顾性分析，在连续的急性缺血性卒中患者的特点是大血管闭塞，涉及acumulostriate arteries。使用支架取栓器对所有患者进行机械血栓切除术。基于位置的缺血基底节的命运根据阿尔伯塔卒中项目早期CT评分（ASPECTS）评估脑梗死（豆状核、尾状核和内囊）和岛叶皮质的血管内再通。在55例患者中观察到脑纹动脉受累（颈内动脉，n = 35;大脑中动脉近端，n = 20）。在豆状核（66.7%）、内囊（11.1%）和尾状核（33.3%）中检测到术前梗死，尽管成功再通，但所有这些梗死均显示继发性进展（分别为85.4%、27.3%和54.5%; p < 0.05）。豆状纹动脉与外侧近端和/或内侧近端的起源显着影响成熟梗死的豆状核的发展。55例患者中有25例检测到术后出血性转化，主要发生在豆状核。基底节区出血性转化的患者中，岛叶带状梗死的发生率明显较高。改良兰金量表评分良好和较差的患者在年龄、初始美国国立卫生研究院卒中量表（NIHSS）评分、初始ASPECTS、术后ASPECTS、术后岛带梗死和大脑中动脉区病变（M-1-M-6）方面存在显著差异。有趣的是，在基底神经节的术后梗死或出血性转化中没有检测到差异。多变量分析显示，只有年龄（p = 0.02，OR 0.88）和初始NIHSS评分（p = 0.01，OR 0.86）独立影响有利的临床outcomes.CONCLUSIONS基底节是脆弱的，容易发展继发性梗死和出血性转化，尽管成功再通。然而，这对累及脑纹动脉的大血管闭塞的急性缺血性卒中的临床结局没有显著影响。
OBJECTIVE Regional 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.METHODS Clinical 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).RESULTS Of 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 (M-1-M-6) 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.CONCLUSIONS The 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.