Skip to main content

Impact of isolated basal ganglia infarction at pretreatment DWI on outcomes after endovascular thrombectomy in acute anterior circulation stroke



Acute infarction confined to the basal ganglia (BG) is occasionally observed on baseline imaging before endovascular thrombectomy. This study aimed to investigate the impact of isolated BG infarction revealed on pretreatment DWI in a large cohort of patients with acute anterior circulation stroke who underwent thrombectomy.


We retrospectively analyzed clinical and DWI data from 328 patients who underwent thrombectomy for emergent occlusions of the intracranial internal carotid artery or the middle cerebral artery. Characteristics and treatment outcomes were compared between patients with isolated BG infarction and those with non-isolated BG infarction. Binary logistic regression analyses were performed to identify independent predictors of good outcome (90-day mRS 0–2).


Isolated BG infarction was found in 57 patients (17.4%). Patients with isolated BG infarction had a higher incidence of underlying severe intracranial atherosclerotic stenosis (21.1% vs. 10.7%, P = 0.032) than those with non-isolated BG infarction. Successful reperfusion occurred more frequently in patients with isolated BG infarction than those with non-isolated BG infarction (93% vs. 79%, odds ratio 3.529, 95% confidence interval 1.226–10.161, P = 0.014). On multivariate logistic regression analysis, independent predictors of good outcome were age, DWI-ASPECTS, and admission NIHSS score. There was no significant difference in the rate of good outcome between the two groups (54.4% vs. 42.8%, P = 0.110).


Isolated BG infarction on pretreatment DWI may predict successful reperfusion after endovascular thrombectomy in patients with acute anterior circulation stroke. In addition, our study suggested a novel finding that isolated BG infarction was more frequently associated with underlying severe ICAS than non-isolated BG infarction.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Min WK, Park KK, Kim YS, Park HC, Kim JY, Park SP, Suh CK (2000) Atherothrombotic middle cerebral artery territory infarction: topographic diversity with common occurrence of concomitant small cortical and subcortical infarcts. Stroke 31:2055–2061

    Article  CAS  PubMed  Google Scholar 

  2. Kleine JF, Beller E, Zimmer C, Kaesmacher J (2017) Lenticulostriate infarctions after successful mechanical thrombectomy in middle cerebral artery occlusion. J Neurointerv Surg 9:234–239

    Article  PubMed  Google Scholar 

  3. Kaesmacher J, Huber T, Lehm M, Zimmer C, Bernkopf K, Wunderlich S, Boeckh-Behrens T, Manning NW, Kleine JF (2017) Isolated striatocapsular infarcts after endovascular treatment of acute proximal middle cerebral artery occlusions: prevalence, enabling factors. and clinical outcome Front Neurol 8:272

    Article  PubMed  Google Scholar 

  4. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC et al (2015) 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:3020–3035

    Article  CAS  PubMed  Google Scholar 

  5. Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, Farrokhyar F, Spears J, Kulkarni AV, Singh S, Alqahtani A, Rochwerg B, Alshahrani M, Murty NK, Alhazzani A, Yarascavitch B, Reddy K, Zaidat OO, Almenawer SA (2015) Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA 314:1832–1843

    Article  CAS  PubMed  Google Scholar 

  6. Yoon W, Kim SK, Park MS, Baek BH, Lee YY (2017) Predictive factors for good outcome and mortality after stent-retriever thrombectomy in patients with acute anterior circulation stroke. J Stroke 19:97–103

    Article  PubMed  PubMed Central  Google Scholar 

  7. Loh Y, Towfighi A, Liebeskind DS, MacArthur DL, Vespa P, Gonzalez NR et al (2009) Basal ganglionic infarction before mechanical thrombectomy predicts poor outcome. Stroke 40:3315–3320

    Article  PubMed  Google Scholar 

  8. Loh Y, Liebeskind DS, Towfighi A, Vespa P, Starkman S, Saver JL, Gonzalez NR, Tateshima S, Jahan R, Shi ZS, Viñuela F, Duckwiler GR (2010) Preprocedural basal ganglionic infarction increases the risk of hemorrhagic transformation but not worse outcome following successful recanalization of acute middle cerebral artery occlusions. World Neurosurg 74:636–640

    Article  PubMed  Google Scholar 

  9. Barber PA, Hill MD, Eliasziw M, Demchuk AM, Pexman JH, Hudon ME et al (2005) ASPECTS Study Group. Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol Neurosurg Psychiatry 76:1528–1533

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Yoon W, Jung MY, Jung SH, Park MS, Kim JT, Kang HK (2013) Subarachnoid hemorrhage in a multimodal approach heavily weighted toward mechanical thrombectomy with Solitaire stent in acute stroke. Stroke 44:414–419

    Article  PubMed  Google Scholar 

  11. Kim SK, Yoon W, Moon SM, Park MS, Jeong GW, Kang HK (2015) Outcomes of manual aspiration thrombectomy for acute ischemic stroke refractory to stent-based thrombectomy. J Neurointerv Surg 7:473–477

    Article  PubMed  Google Scholar 

  12. Yoon W, Kim SK, Park MS, Kim BC, Kang HK (2015) Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery 76:680–686

    Article  PubMed  Google Scholar 

  13. Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, Marks MP, Prabhakaran S, Kallmes DF, Fitzsimmons BFM, Mocco J, Wardlaw JM, Barnwell SL, Jovin TG, Linfante I, Siddiqui AH, Alexander MJ, Hirsch JA, Wintermark M, Albers G, Woo HH, Heck DV, Lev M, Aviv R, Hacke W, Warach S, Broderick J, Derdeyn CP, Furlan A, Nogueira RG, Yavagal DR, Goyal M, Demchuk AM, Bendszus M, Liebeskind DS (2013) Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44:2650–2663

    Article  PubMed  PubMed Central  Google Scholar 

  14. Larrue V, von Kummer R, Müller A, Bluhmki E (2001) Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke 32:438–441

    Article  CAS  PubMed  Google Scholar 

  15. Liebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL, Investigators SWIFT (2014) Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy. Stroke 45:2036–2040

    Article  PubMed  PubMed Central  Google Scholar 

  16. Singer OC, Berkefeld J, Nolte CH, Bohner G, Reich A, Wiesmann M, Groeschel K, Boor S, Neumann-Haefelin T, Hofmann E, Stoll A, Bormann A, Liebeskind DS (2015) Collateral vessels in proximal middle cerebral artery occlusion: the ENDOSTROKE study. Radiology 274:851–858

    Article  PubMed  Google Scholar 

  17. Leng X, Fang H, Leung TW, Mao C, Xu Y, Miao Z et al (2016) Impact of collateral status on successful revascularization in endovascular treatment: a systematic review and meta-analysis. Cerebrovasc Dis 41:27–34

    Article  PubMed  Google Scholar 

  18. Yoo AJ, Andersson T (2017) Thrombectomy in acute ischemic stroke: challenges to procedural success. J Stroke 19:121–130

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kim SJ, Seok JM, Bang OY, Kim GM, Kim KH, Jeon P, Chung CS, Lee KH, Alger JR, Liebeskind DS (2009) MR mismatch profiles in patients with intracranial atherosclerotic stroke: a comprehensive approach comparing stroke subtypes. J Cereb Blood Flow Metab 29:1138–1145

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee JS, Hong JM, Kim JS (2017) Diagnostic and therapeutic strategies for acute intracranial atherosclerosis-related occlusions. J Stroke 19:143–151

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK (2004) Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke. Stroke 35:4876–4881

    Article  Google Scholar 

  22. Lee KB, Oh HG, Roh H, Ahn MY (2008) Can we discriminate stroke mechanisms by analyzing the infarct patterns in the striatocapsular region? Eur Neurol 60:79–84

    Article  PubMed  Google Scholar 

  23. Lee YY, Yoon W, Kim SK, Baek BH, Kim GS, Kim JT, Park MS (2017) Acute basilar artery occlusion: differences in characteristics and outcomes after endovascular therapy between patients with and without underlying severe atherosclerotic stenosis. AJNR Am J Neuroradiol 38:1600–1604

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Woong Yoon.

Ethics declarations


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Baek, B.H., Yoon, W., Lee, Y.Y. et al. Impact of isolated basal ganglia infarction at pretreatment DWI on outcomes after endovascular thrombectomy in acute anterior circulation stroke. Neuroradiology 61, 89–96 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Acute stroke
  • Cerebrovascular disease
  • Endovascular treatment
  • Endovascular recanalization
  • Diffusion-weighted imaging