Distance to Thrombus in acute middle cerebral artery stroke predicts basal ganglia infarction after mechanical thrombectomy

Background and Purpose: This study examines if involvement of the lenticulostriate arteries (LSAs) in MCA stroke and consecutive infarction of the basal ganglia can be predicted by the exact occlusion site, as determined in preinterventional CT or MRI imaging. Methods: Retrospective analysis of 212 patients with acute isolated MCA occlusions treated with mechanical thrombectomy. The occlusion site was assessed using the Distance to Thrombus (DT). Affection of LSAs by the occlusion was determined by analysis of pre- and post-interventional DSA runs. Infarction of the striatocapsular region was evaluated in post-interventional imaging. Results: DT showed a highly significant correlation with the affected LSA group (ρ = 0.747; P < 0.001). In a ROC analysis, DT could predict affection of the LSAs with an area under the curve (AUC) of 0.903. Additionally, DT could predict an infarction of the striatocapsular region with an AUC of 0.824. In a stepwise regression analysis for striatocapsular infarction including DT, age, time from symptom onset to recanalization and recanalization success, only DT proved to be an independent predictor. Conclusion: In MCA stroke, the exact site of the occlusion as measured by DT independently predicts the involvement of LSAs and subsequent striatocapsular infarction with high sensitivity and specificity.