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Article

Involvement of Subinsular Territory Stroke as Predictor of Outcome after Successful Endovascular Recanalization of Left Middle Cerebral Artery Occlusion

1
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita 010-0874, Japan
2
Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai 980-8575, Japan
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Brain Sci. 2024, 14(9), 885; https://doi.org/10.3390/brainsci14090885
Submission received: 6 August 2024 / Revised: 24 August 2024 / Accepted: 29 August 2024 / Published: 30 August 2024
(This article belongs to the Special Issue Initial Assessment and Management of Acute Stroke)

Abstract

Subinsular stroke (subIS) can occur between the penetrating middle cerebral artery (MCA) branches, which clinical and radiological findings sometimes encounter in patients after the recanalization of left proximal MCA occlusion. However, no supportive data are available to clarify this relationship. This study investigated whether the involvement of subIS can impact outcomes after successful reperfusion therapy. Data from 152 consecutive patients who underwent endovascular thrombectomy between 2019 and 2023 were collected. A 3-month functional independence defined as a modified Rankin Scale 0–2 (primary outcome) and influencing factors were analyzed retrospectively. Recanalization was achieved in 35 patients, of whom 11 (31%) developed subIS. Patients with subIS were older in age (81 vs. 75; p < 0.05), had lower apparent diffusion coefficient (ADC) values on admission (0.52 vs. 0.62; p < 0.001), and higher modified Rankin Scale (mRS) scores (4 vs. 2; p < 0.001) than those without subIS. In a multivariate analysis, subIS was independently associated with a worse functional outcome (odds ratio: 10.5, p = 0.02). The cut-off value of the ADCs was 0.52 with a sensitivity and specificity of 70% and 64%, respectively. Subinsular ischemic lesions contribute to poor functional independence in patients after the successful recanalization of left MCA occlusion. The attenuation of the ADC value in these territories could be a valuable predictor of the outcome.
Keywords: acute ischemic stroke; clinical outcome; endovascular therapy; futile recanalization; middle cerebral artery; subinsular territory acute ischemic stroke; clinical outcome; endovascular therapy; futile recanalization; middle cerebral artery; subinsular territory

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MDPI and ACS Style

Yoshida, Y.; Mutoh, T.; Tatewaki, Y.; Taki, Y.; Moroi, J.; Ishikawa, T. Involvement of Subinsular Territory Stroke as Predictor of Outcome after Successful Endovascular Recanalization of Left Middle Cerebral Artery Occlusion. Brain Sci. 2024, 14, 885. https://doi.org/10.3390/brainsci14090885

AMA Style

Yoshida Y, Mutoh T, Tatewaki Y, Taki Y, Moroi J, Ishikawa T. Involvement of Subinsular Territory Stroke as Predictor of Outcome after Successful Endovascular Recanalization of Left Middle Cerebral Artery Occlusion. Brain Sciences. 2024; 14(9):885. https://doi.org/10.3390/brainsci14090885

Chicago/Turabian Style

Yoshida, Yasuyuki, Tatsushi Mutoh, Yasuko Tatewaki, Yasuyuki Taki, Junta Moroi, and Tatsuya Ishikawa. 2024. "Involvement of Subinsular Territory Stroke as Predictor of Outcome after Successful Endovascular Recanalization of Left Middle Cerebral Artery Occlusion" Brain Sciences 14, no. 9: 885. https://doi.org/10.3390/brainsci14090885

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