Infarct Location Matters: Basal Ganglia Involvement Predicts Poor Outcomes despite Successful Endovascular Thrombectomy in Large Vessel Occlusion Stroke.

Purpose: Infarct location may significantly influence clinical outcomes in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). This study aimed to investigate the impact of basal ganglia (BG) infarction on outcomes in AIS patients with large vessel occlusion (LVO) who achieved successful recanalization.

Materials And Methods: We retrospectively analyzed consecutive AIS patients who underwent EVT at our center between March 2016 and January 2019. Patients with LVO who achieved successful recanalization (modified Thrombolysis in Cerebral Infarction ≥2b) were included. Preprocedural diffusion-weighted imaging (DWI) was used to identify BG infarction. Poor outcome was defined as a 3-month modified Rankin Scale score of 3-6. Multivariate logistic regression analysis was performed to identify independent predictors of poor outcome.

Results: A total of 222 patients were included, of whom 160 (72.1%) had BG infarction. Independent predictors of poor outcome included older age (odds ratio [OR], 1.10; P<0.001), higher National Institute of Health Stroke Scale scores (OR, 1.20; P<0.001), lower DWI-Alberta Stroke Program Early Computed Tomography Scores (OR, 0.79; P=0.009), hemorrhagic transformation (OR, 2.97; P=0.031), and BG infarction (OR, 4.14; P=0.002).

Conclusion: BG infarction was independently associated with poor outcome despite successful recanalization. These findings underscore the prognostic importance of infarct location and support the need for tailored treatment strategies in AIS patients with BG involvement.