Evaluating post‐thrombectomy effective connectivity changes in anterior circulation stroke

Abstract Objective Granger causal analysis (GCA) and amplitude of low‐frequency fluctuation (ALFF) are commonly used to evaluate functional alterations in brain disorders. By combining the GCA and ALFF, this study aimed to investigate the effective connectivity (EC) changes in patients with acute ischemic stroke (AIS) and anterior circulation occlusion after mechanical thrombectomy (MT). Methods Resting‐state functional magnetic resonance imaging (rs‐fMRI) data were collected from 43 AIS patients with anterior circulation occlusion within 1 week post‐MT and 37 healthy controls. ALFF and GCA were calculated for each participant. Patients were further divided into groups based on prognosis and perfusion levels. The differences in ALFF and EC were compared between AIS patients and healthy controls and between subgroups of patients. Pearson correlations between EC, ALFF values, and clinical characteristics of patients were calculated. Results Compared to healthy controls, post‐MT, AIS patients exhibited significant ALFF increases in the left precuneus and decreases in the left fusiform gyrus and right caudate. Increased EC from the contralesional lingual gyrus, contralesional putamen, ipsilesional thalamus, and contralesional thalamus to the contralesional caudate was obsrved, while decrease in EC were found for contralesional caudate to the ipsilesional thalamus and medial superior frontal gyrus. EC differences were particularly notable between perfusion groups, with significantly lower EC in the poorly perfused group. EC values were also positively correlated with National Institutes of Health Stroke Scale (NIHSS) scores pre‐MT. Interpretation In AIS patients, the caudate nucleus was central to the observed EC changes post‐MT, characterized by decreased outputs and increased inputs. These changes indicate functional remodeling within the cortico‐basal ganglia‐thalamic‐cortical pathway.