Anatomical predictors of gastrostomy tube placement after large vessel occlusion ischemic stroke

Dysphagia is a common neurologic deficit following ischemic stroke. As a result, patients often require percutaneous endoscopic gastrostomy (PEG) tube placement for safe maintenance of sufficient caloric intake. Right hemispheric strokes have previously been associated with post-stroke dysphagia. We examined whether topographic location of post-large vessel occlusion (LVO) stroke MR diffusion-weighted imaging (DWI) lesions associated with the need for placement of PEG tube. A retrospective registry of 898 patients evaluated for acute treatment of suspected LVO stroke was used. Sixty-five patients underwent post-stroke PEG placement, and 65 additional patients were selected as propensity matches based on age, baseline NIH Stroke Scale score, and recanalization status. Binary masks of 24-72-h post-stroke DWI lesions were co-registered to standard template space. Voxel-based lesion symptom mapping (V2.55), rewritten to perform logistic regression at each voxel, was used to generate statistical maps of lesion contribution to PEG placement. Results: Uncorrected t-statistic maps demonstrated voxels in the right frontal, parietal, and temporal regions were associated with post-stroke PEG placement. Upon controlling for age and/or recanalization status, lesions in the right parietal lobe were associated with need for PEG. After controlling for lesion volume, this association weakened. After controlling for all variables, there were no topographical regions associated with PEG placement. There does not appear to be any topographic region on post-stroke diffusion MRI that is significantly associated with need for PEG placement in patients with LVO stroke after controlling for age, recanalization status, and lesion size.