Department of Radiology (T.D.F., R.K., G.M.K., M.P.M., M.W., J.J.H.), Stanford University School of Medicine, CA.
Department of Neurology and Neurological Sciences (S.C., M.M., M.G.L., G.W.A.), Stanford University School of Medicine, CA.
Stroke. 2021 May;52(5):1761-1767. doi: 10.1161/STROKEAHA.120.032242. Epub 2021 Mar 8.
Patients with acute ischemic stroke due to large vessel occlusion and favorable tissue-level collaterals (TLCs) likely have robust cortical venous outflow (VO). We hypothesized that favorable VO predicts robust TLC and good clinical outcomes.
Multicenter retrospective cohort study of consecutive acute ischemic stroke due to large vessel occlusion patients who underwent thrombectomy triage. Included patients had interpretable prethrombectomy computed tomography, computed tomography angiography, and cerebral perfusion imaging. TLCs were measured on cerebral perfusion studies using the hypoperfusion intensity ratio (volume ratio of brain tissue with [Tmax >10 s/Tmax >6 s]). VO was determined by opacification of the vein of Labbé, sphenoparietal sinus, and superficial middle cerebral vein on computed tomography angiography as 0, not visible; 1, moderate opacification; and 2, full. Clinical and demographic data were determined from the electronic medical record. Using multivariable regression analyses, we determined the association between VO and (1) favorable TLC status (defined as hypoperfusion intensity ratio ≤0.4) and (2) good functional outcome (modified Rankin Scale score, 0-2).
Six hundred forty-nine patients met inclusion criteria. Patients with favorable VO were younger (median age, 72 [interquartile range (IQR), 62-80] versus 77 [IQR, 66-84] years), had a lower baseline National Institutes of Health Stroke Scale (median, 12 [IQR, 7-17] versus 19 [IQR, 13-20]), and had a higher Alberta Stroke Program Early Computed Tomography Score (median, 9 [IQR, 7-10] versus 7 [IQR, 6-9]). Favorable VO strongly predicted favorable TLC (odds ratio, 4.5 [95% CI, 3.1-6.5]; <0.001) in an adjusted regression analysis. Favorable VO also predicted good clinical outcome (odds ratio, 10 [95% CI, 6.2-16.0]; <0.001), while controlling for favorable TLC, age, glucose, baseline National Institutes of Health Stroke Scale, and good vessel reperfusion status.
In this selective retrospective cohort study of acute ischemic stroke due to large vessel occlusion patients undergoing thrombectomy triage, favorable VO profiles correlated with favorable TLC and were associated with good functional outcomes after treatment. Future prospective studies should independently validate our findings.
由于大血管闭塞导致急性缺血性卒中且具有良好的组织水平侧支循环（TLCs）的患者可能具有强大的皮质静脉回流（VO）。我们假设良好的 VO 可预测强大的 TLC 和良好的临床结果。
对接受取栓治疗的大血管闭塞性急性缺血性卒中连续患者进行的多中心回顾性队列研究。纳入的患者有可解释的术前 CT、CT 血管造影和脑灌注成像。在脑灌注研究中，通过 Tmax＞10s/Tmax＞6s 的脑血流量比值来测量 TLCs。VO 通过 CT 血管造影上的 Labbe 静脉、蝶顶窦和大脑浅中静脉的显影程度来确定，分别为 0（不可见）、1（中度显影）和 2（完全显影）。临床和人口统计学数据来自电子病历。使用多变量回归分析，我们确定了 VO 与（1）良好的 TLC 状态（定义为低灌注强度比≤0.4）和（2）良好的功能结局（改良 Rankin 量表评分，0-2）之间的关联。
649 例患者符合纳入标准。VO 良好的患者年龄更小（中位数，72 [四分位距（IQR），62-80] 岁 vs 77 [IQR，66-84] 岁），基线 NIHSS 评分更低（中位数，12 [IQR，7-17] 分 vs 19 [IQR，13-20] 分），Alberta 卒中项目早期 CT 评分更高（中位数，9 [IQR，7-10] 分 vs 7 [IQR，6-9] 分）。在调整后的回归分析中，VO 良好强烈预测 TLC 良好（优势比，4.5 [95%可信区间，3.1-6.5]；<0.001）。VO 良好也预测了良好的临床结局（优势比，10 [95%可信区间，6.2-16.0]；<0.001），同时控制了 TLC 良好、年龄、血糖、基线 NIHSS 评分和良好的血管再通状态。
在这项对接受取栓治疗的大血管闭塞性急性缺血性卒中患者的选择性回顾性队列研究中，VO 良好的患者与 TLC 良好相关，且与治疗后的良好功能结局相关。未来的前瞻性研究应独立验证我们的发现。
