Early venous drainage after successful endovascular recanalization in ischemic stroke -- a predictor for final infarct volume?

INTRODUCTION

Peri-ischemic early venous filling (PEVD) has been reported to occur at certain stages of brain infarction and has previously been termed as "luxury perfusion". We report on the significance of PEVD after a successful endovascular recanalization.

METHODS

We retrospectively evaluated all patients who underwent endovascular stroke treatment from February 2006 to April 2010 in two centers. PEVD was rated as present or absent. Infarction was evaluated on computed tomography (CT) ≥ 18 h post-treatment. Localization of the PEVD and the infarction was noted for the anterior and posterior circulation; for the anterior circulation, also deep and superficial veins/brain regions were defined.

RESULTS

A total of 151 of the 175 patients developed an infarct. Of these 151 patients, 118 had PEVD (sensitivity 78.1%); meanwhile, 20 of 24 patients without an infarction had no PEVD (specificity 83.3%). Consistent localization of the PEVD and the infarct was seen in 107/151 patients (70.9%); in 28 of these 107 cases, the territory of PEVD was smaller than the infarct (26.2%) and exceeded it in 7/107 patients (5.6%). Territorial congruency of the PEVD and the final infarct was 57.6-75% for deep/superficial brain regions of the anterior, but only 16.7% for the posterior circulation. Separate evaluation for the anterior circulation resulted in a 94.9% sensitivity and an 81.0% specificity.

CONCLUSION

PEVD is a potential angiographic predictor for irreversible regional tissue damage and subsequent infarction despite successful recanalization. This finding deserves further studies and may influence therapeutic decisions such as post-treatment anticoagulative medication. It may also be considered in potential refined classifications of angiographic reperfusion success in the future.