Involvement of the Right Lentiform Nucleus is an Independent Predictor of Poor Outcomes in Large Vessel Occlusion Strokes with Small Infarct Volumes

 You described something BUT INCOMPETENTLY DID NOTHING TO SOLVE THE PROBLEM! YOU'RE FIRED!

In what multiverse do you live where predicting poor outcomes helps survivors recover?

Involvement of the Right Lentiform Nucleus is an Independent Predictor of Poor Outcomes in Large Vessel Occlusion Strokes with Small Infarct

Author links open overlay panel, , , , , , , 

https://doi.org/10.1016/j.clineuro.2025.109137Get rights and content

Highlights

• •
  Although a small final infarct volume (FIV) was achieved following successful thrombectomy, approximately 30% of patients still experienced poor outcomes at 3 months.
• •
  There is no universally accepted definition of a small FIV; in this study, two thresholds were used: <30 ml and <10.88 ml, the latter representing the 25th percentile of the cohort.
• •
  Independent predictors of unfavorable outcomes included older age, coronary artery disease (CAD), a history of previous stroke, cardioembolic stroke etiology, and the number of mechanical thrombectomy (MT) attempts.
• •
  Analysis using AI-based software to assess affected ASPECTS regions identified the right lentiform nucleus as an independent predictor of poor outcomes in patients with FIV ≤30 ml and also those with FIV ≤10.88 ml.

Abstract

Background

Final infarct volume (FIV) is a strong predictor of stroke outcomes. Although smaller FIV are associated with better outcomes, many patients fail to achieve functional independence. We aimed to identify poor outcome predictors in patients with anterior large vessel occlusion stroke (LVOS) who underwent mechanical thrombectomy (MT) and had small FIV.

Methods

We reviewed a prospective MT database from October 2010 to December 2020. Patients with intracranial ICA or MCA-M1/2 occlusions, premorbid mRS ≤2, underwent MT, and had FIV ≤30 ml on follow-up MRI were included. The cohort was divided into: good (mRS≤2) and poor (mRS>2) outcomes at 90 days. Multivariable analysis identified the poor outcome predictors and the association between e-ASPECTS regions and outcomes.

Results

Among 2370 thrombectomies, 555 had FIV ≤30 ml. After exclusions, 398 patients were analyzed. The median age was 65 years, with 54% female, median NIHSS was 15, and the median ASPECTS was 9. Poor outcome was associated with older age, female sex, atrial fibrillation (AF), hypertension (HTN), coronary artery disease (CAD), and prior strokes. Right lentiform nucleus involvement is an independent predictor of poor outcome in patients with small FIV, along with age, CAD, cardioembolic stroke, number of MT attempts and FIV.

Conclusion

Involvement of right lentiform nucleus is an independent predictor of poor outcomes in LVOS with small FIV. Other predictors included age, CAD, cardioembolic stroke, the number of passes during MT, and FIV. Future strategies are needed to improve outcomes in these patient populations.