Zhang Sheng, Lai Yangxiao, Ding Xinfa, Parsons Mark, Zhang John H, Lou Min
From the Departments of Neurology (S.Z., Y.L., M.L.) and Radiology (X.D.), The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology, John Hunter Hospital, The University of Newcastle, NSW, Australia (M.P.); and Department of Physiology and Pharmacology, Loma Linda University, CA (J.H.Z.).
Stroke. 2017 Apr;48(4):907-914. doi: 10.1161/STROKEAHA.116.016174. Epub 2017 Mar 6.
Our aim was to study the effect of drainage of cortical veins, including the superficial middle cerebral vein (SMCV), vein of Trolard, and vein of Labbé on neurological outcomes after reperfusion therapy.
Consecutive ischemic stroke patients who underwent pretreatment computed tomographic perfusion and 24-hour computed tomographic perfusion or magnetic resonance perfusion after intravenous thrombolysis were included. We defined "absent filling of ipsilateral cortical vein" (eg, SMCV-) as no contrast filling of the vein across the whole venous phase on 4-dimensional computed tomographic angiography in the ischemic hemisphere.
Of 228 patients, SMCV-, vein of Trolard- and vein of Labbé- were observed in 50 (21.9%), 27 (11.8%), and 32 (14.0%) patients, respectively. Only SMCV- independently predicted poor outcome (3-month modified Rankin Scale score of >2; odds ratio, 2.710; =0.040). No difference was found in reperfusion rate after treatment between patients with and without SMCV- (>0.05). In patients achieving major reperfusion (≥80%), there was no difference in 24-hour infarct volume, or rate of poor outcome between patients with and without SMCV- (>0.05). However, in those without major reperfusion, patients with SMCV- had larger 24-hour infarct volume (=0.011), higher rate of poor outcome (=0.012), and death (=0.032) compared with those with SMCV filling. SMCV- was significantly associated with brain edema at 24 hours (=0.037), which, in turn, was associated with poor 3-month outcome (=0.002).
Lack of SMCV filling contributed to poor outcome after thrombolysis, especially when reperfusion was not achieved. The main deleterious effect of poor venous filling appears related to the development of brain edema.
我们的目的是研究皮质静脉引流，包括大脑中浅静脉（SMCV）、Trolard静脉和Labbé静脉对再灌注治疗后神经功能结局的影响。
纳入连续的缺血性卒中患者，这些患者在静脉溶栓前接受了计算机断层扫描灌注检查，并在静脉溶栓后24小时接受了计算机断层扫描灌注或磁共振灌注检查。我们将“同侧皮质静脉无充盈”（例如，SMCV-）定义为在缺血半球的四维计算机断层血管造影的整个静脉期静脉内无造影剂充盈。
在228例患者中，分别有50例（21.9%）、27例（11.8%）和32例（14.0%）观察到SMCV-、Trolard静脉-和Labbé静脉-。只有SMCV-独立预测预后不良（3个月改良Rankin量表评分>2；比值比，2.710；P=0.040）。有无SMCV-的患者治疗后的再灌注率无差异（P>0.05）。在实现主要再灌注（≥80%）的患者中，有无SMCV-的患者在24小时梗死体积或不良预后率方面无差异（P>0.05）。然而，在未实现主要再灌注的患者中，与SMCV有充盈的患者相比，SMCV-的患者24小时梗死体积更大（P=0.011），不良预后率更高（P=0.012），死亡率更高（P=0.032）。SMCV-与24小时脑水肿显著相关（P=0.037），而脑水肿又与3个月预后不良相关（P=0.002）。
SMCV无充盈导致溶栓后预后不良，尤其是在未实现再灌注时。静脉充盈不良的主要有害影响似乎与脑水肿的发生有关。
