Venous Outflow Profiles Are Linked to Clinical Outcomes in Ischemic Stroke Patients with Extensive Baseline Infarct
Winkelmeier Laurens, Broocks Gabriel, Kniep Helge, Geest Vincent, Reinwald Jonathan, Meyer Lukas, Horn Noel van, Guenego Adrien, Zelenkk Kamil, Albers Gregory W, Lansberg Maarten, Sporns Peter, Wintermark Max, Fiehler Jens, Heit Jeremy J., Faizy Tobias D.,
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( Winkelmeier Laurens )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Broocks Gabriel )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Kniep Helge )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Geest Vincent )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Reinwald Jonathan )
Medical Faculty Mannheim Central Institute of Mental Health
( Meyer Lukas )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Horn Noel van )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Guenego Adrien )
Erasme Medical Center Department of Neuroradiology
( Zelenkk Kamil )
Comenius University Department of Radiology
( Albers Gregory W )
Stanford University School of Medicine Department of Neurology
( Lansberg Maarten )
Stanford University Department of Neurology
( Sporns Peter )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Wintermark Max )
MD Andersen Cancer Center Department of Neuroradiology
( Fiehler Jens )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
( Heit Jeremy J. )
Stanford University School of Medicine Department of Radiology
( Faizy Tobias D. )
University Medical Center Hamburg-Eppendorf Department of Diagnostic and Interventional Neuroradiology
Abstract
Background and purpose: The benefit of endovascular thrombectomy (EVT) treatment is still unclear in stroke patients presenting with extensive baseline infarct. The use of additional imaging biomarkers could improve clinical outcome prediction and individualized EVT selection in this vulnerable cohort. We hypothesized that cerebral venous outflow (VO) may be associated with functional outcomes in patients with low Alberta Stroke Program Early CT Score (ASPECTS).
Methods: We conducted a retrospective multicenter cohort study of patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Extensive baseline infarct was defined by an ASPECTS of ≤5 on admission computed tomography (CT). VO profiles were assessed on admission CT angiography using the Cortical Vein Opacification Score (COVES). Favorable VO was defined as COVES ≥3. Multivariable logistic regression was used to determine the association between cerebral VO and good clinical outcomes (90-day modified Rankin Scale score of ≤3).
Results: A total of 98 patients met the inclusion criteria. Patients with extensive baseline infarct and favorable VO achieved significantly more often good clinical outcomes compared to patients with unfavorable VO (45.5% vs. 10.5%, P<0.001). Higher COVES were strongly associated with good clinical outcomes (odds ratio, 2.17; 95% confidence interval, 1.15 to 4.57; P=0.024), independent of ASPECTS, National Institutes of Health Stroke Scale, and success of EVT.
Conclusions: Cerebral VO profiles are associated with good clinical outcomes in AIS-LVO patients with extensive baseline infarct. VO profiles could serve as a useful additional imaging biomarker for treatment selection and outcome prediction in low ASPECTS patients.
키워드
Cerebral edema; Cerebrovascular circulation; Ischemic stroke; Neuroimaging; Thrombectomy.
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