Background: Striatocapsular infarcts (SCIs) are defined as large subcortical
infarcts involving the territory of more than one lenticulostriate artery. SCI
without concomitant ischemia in the more distal middle cerebral artery (MCA)
territory [isolated SCI (iSCI)] has been described as a rare infarct pattern.
The purpose of this study was to assess the prevalence of iSCI in patients
treated with endovascular thrombectomy (ET), to evaluate baseline and
procedural parameters associated with this condition, and to describe the
clinical course of iSCI patients. Methods: A retrospective analysis of 206
consecutive patients with an isolated MCA occlusion involving the
lenticulostriate arteries and treated with ET was performed. Baseline patient
and procedural characteristics and ischemic involvement of the striatocapsular
and distal MCA territory [iSCI, as opposed to non-isolated SCI (niSCI)] were
analyzed using multivariate logistic regression models. Prevalence of iSCI was
assessed, and clinical course was determined with the rates of substantial
neurological improvement and good functional short- and mid-term outcome
(discharge/day 90 Modified Rankin Scale ≤2). Results: iSCI was detected in 53
patients (25.7%), and niSCI was detected in 153 patients (74.3%). Successful
reperfusion [thrombolysis in cerebral infarction (TICI) 2b/3] [adjusted odds
ration (aOR) 8.730, 95% confidence interval (95% CI) 1.069–71.308] and good
collaterals (aOR 2.100, 95% CI 1.119–3.944) were associated with iSCI. In
successfully reperfused patients, TICI 3 was found to be an additional factor
associated with iSCI (aOR 5.282, 1.759–15.859). Patients with iSCI had higher
rates of substantial neurological improvement (71.7 vs. 37.9%, p < 0.001) and
higher rates of good functional short- and mid-term outcome (58.3 vs. 23.7%, p
< 0.001 and 71.4 vs. 41.7%, p < 0.001). However, while iSCI patients, in
general, had a more favorable outcome, considerable heterogeneity in outcome
was observed. Conclusion: High rates of successful reperfusion (TICI 2b/3) and
in particular, complete reperfusion (TICI 3) are associated with iSCIs. The
high prevalence of iSCI in successfully reperfused patients with good
collaterals corroborates previous concepts of iSCI pathogenesis. iSCI, once
considered a rare pattern of cerebral ischemia, is likely to become more
prevalent with increases in endovascular stroke therapy. This may have
implications for patient rehabilitation and pathophysiological analyses of
ischemic damage confined to subcortical regions of the MCA territory