Bhaskar Sonu, Bivard Andrew, Parsons Mark, Nilsson Michael, Attia John R, Stanwell Peter, Levi Christopher
1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.
2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
J Cereb Blood Flow Metab. 2017 Feb;37(2):671-682. doi: 10.1177/0271678X16637611. Epub 2016 Jul 20.
Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomenon, delayed-late venous phase cortical vein filling, observed on dynamic computed tomography angiography obtained using multidetector computed tomography scanner, in acute ischemic stroke patients. The aim of this study was to examine the frequency of delayed-late venous phase cortical vein filling and assess its association to baseline collateral status. Dynamic computed tomography angiography images of acute ischemic stroke patients, being assessed for reperfusion therapy, were prospectively studied. Delayed-late venous phase cortical vein filling was defined by late venous phase opacification of cortical veins despite contrast clearance from contralateral cortical veins on dynamic computed tomography angiography. Time to peak of maximum arterial enhancement was recorded. A total of 117 patients (mean age = 70.6 ± 13.3 years; males = 48%) with hemispheric ischemic stroke who underwent acute dynamic computed tomography angiography were included in the study. Overall, 56 (48%) demonstrated delayed-late venous phase cortical vein filling. Poor collateralization (OR = 13.50; 95% CI = (4.2, 43); p ≤ 0.0001) and longer time to peak of maximum arterial enhancement (OR = 3.2; 95% CI = (1.96, 5.3); p ≤ 0.0001) were positively associated with delayed-late venous phase cortical vein filling. Delayed-late venous phase cortical vein filling was independently associated with poor baseline collateral status (75% vs. 15%, p ≤ 0.0001; OR = 14.38; 95% CI = (4.33, 47.8); p ≤ 0.0001). Delayed-late venous phase cortical vein filling is frequently seen in patients with acute ischemic stroke and is associated with poor baseline collateralization.
评估静脉系统可能有助于预测中风预后以及选择适合急性干预策略的患者。我们报告了一种在使用多排螺旋计算机断层扫描扫描仪进行的动态计算机断层血管造影中观察到的新现象，即急性缺血性中风患者出现延迟晚期皮质静脉充盈。本研究的目的是检查延迟晚期皮质静脉充盈的频率，并评估其与基线侧支循环状态的关联。对正在接受再灌注治疗评估的急性缺血性中风患者的动态计算机断层血管造影图像进行前瞻性研究。延迟晚期皮质静脉充盈定义为在动态计算机断层血管造影中，尽管对侧皮质静脉内造影剂已清除，但皮质静脉在静脉晚期仍有造影剂充盈。记录最大动脉强化峰值出现的时间。共有117例半球缺血性中风患者（平均年龄=70.6±13.3岁；男性=48%）接受了急性动态计算机断层血管造影，并纳入本研究。总体而言，56例（48%）出现延迟晚期皮质静脉充盈。侧支循环不良（比值比=13.50；95%置信区间=（4.2，43）；p≤0.0001）和最大动脉强化峰值出现时间较长（比值比=3.2；95%置信区间=（1.96，5.3）；p≤0.0001）与延迟晚期皮质静脉充盈呈正相关。延迟晚期皮质静脉充盈与基线侧支循环状态不良独立相关（75%对15%，p≤0.0001；比值比=14.38；95%置信区间=（4.33，47.8）；p≤0.0001）。延迟晚期皮质静脉充盈在急性缺血性中风患者中常见，且与基线侧支循环不良有关。
