Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, 734 8551Hiroshima, Japan; Department of Neurosurgery and interventional neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Department of Neurosurgery and interventional neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104926. doi: 10.1016/j.jstrokecerebrovasdis.2020.104926. Epub 2020 Jun 5.
Early venous filling after endovascular mechanical thrombectomy in acute ischemic stroke (AIS) is a specific finding that may serve as a biomarker for intracranial hemorrhage. However, the pathophysiology of early venous filling and postoperative hemorrhage remains unclear. The aim of this study was to investigate correlation between early venous filling and various factors involving patient demographics and perioperative imaging.
We prospectively analyzed 35 patients with AIS due to cardioembolism (CE) who underwent successful acute revascularization (TICI ≥2). Ischemic lesions were scored by magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Outcomes were assessed using the modified Rankin Scale (mRS) 90 days after stroke onset. Blood flow analysis was evaluated by MRI with arterial spin labeling (ASL). Early venous filling was assessed by digital subtraction angiography (DSA). Univariate analysis was performed to investigate correlations between early venous filling and patient demographics and imaging findings.
Early venous filling was observed in 22 of 35 (66%) patients after reperfusion therapy. There was a significant correlation between early venous filling and DWI-ASPECTS (6.2 vs 8.8, p=0.0003), outcome (5 vs 9, p=0.006), hyperperfusion (17 vs 1, p< 0.0001), and hemorrhagic transformation (17 vs 1, p=0.005).
This comprehensive study revealed that early venous filling after reperfusion therapy is associated with postoperative hyperperfusion. Early venous filling may be a marker of the process of hyperperfusion, leading to hemorrhage and an unfavorable outcome. Detection of early venous filling may be an important finding on DSA for subsequent intensive perioperative management.
急性缺血性脑卒中（AIS）血管内机械取栓术后早期静脉充盈是一种特定的表现，可能作为颅内出血的生物标志物。然而，早期静脉充盈和术后出血的病理生理学机制尚不清楚。本研究旨在探讨早期静脉充盈与涉及患者人口统计学和围手术期影像学的各种因素之间的相关性。
我们前瞻性分析了 35 例因心源性栓塞（CE）导致 AIS 并成功进行急性再通（TICI ≥2）的患者。通过磁共振成像（MRI）弥散加权成像（DWI）对缺血性病变进行评分。使用改良 Rankin 量表（mRS）在卒中发病后 90 天评估结果。通过 MRI 动脉自旋标记（ASL）评估血流分析。通过数字减影血管造影（DSA）评估早期静脉充盈。采用单变量分析来探讨早期静脉充盈与患者人口统计学和影像学发现之间的相关性。
再灌注治疗后 35 例患者中有 22 例（66%）出现早期静脉充盈。早期静脉充盈与 DWI-ASPECTS（6.2 与 8.8，p=0.0003）、结局（5 与 9，p=0.006）、高灌注（17 与 1，p<0.0001）和出血性转化（17 与 1，p=0.005）之间存在显著相关性。
这项综合研究表明，再灌注治疗后早期静脉充盈与术后高灌注有关。早期静脉充盈可能是高灌注过程的标志物，导致出血和不良结局。DSA 上检测到早期静脉充盈可能是随后强化围手术期管理的重要发现。
