Preprocedural Basal Ganglionic Infarction Increases the Risk of Hemorrhagic Transformation but Not Worse Outcome Following Successful Recanalization of Acute Middle Cerebral Artery Occlusions

ObjectiveWe recently demonstrated that the preprocedural magnetic resonance imaging (MRI) pattern of deep middle cerebral artery (MCA) territory injury predicts poor prognosis. We postulate that the structures of the deep MCA field are particularly vulnerable to hemorrhagic transformation (HT) following reperfusion.MethodsWe reviewed all cases of acute occlusions involving the M1 segment of the MCA with diffusion restriction of at least 50% of the deep MCA field on MRI (M1a pattern) that underwent endovascular therapy. We compared those with and without recanalization in regards to HT and disability on discharge.ResultsThirty-five patients met inclusion criteria. The recanalized M1a group (n = 27) had higher rates of HT (67% vs. 25%, P = 0.05) and a trend toward more parenchymal HT (37% vs. 0%, P = 0.07) and symptomatic HT (22% vs. 0%, P = 0.12) than those M1a patients who failed to recanalize (n = 8). Clinical improvement in the National Institutes of Health Stroke Scale by discharge was better in the survivors of the recanalized group.ConclusionsAmong patients with the preintervention M1a MRI pattern of advanced basal ganglionic injury, successful recanalization predicts a higher risk of HT but better outcome.