Lin Jia'Xing, Cheng Zhong'Yuan, Shi Ying'Ying, Cai Xiang'Ran, Huang Li'An
Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Front Neurol. 2021 Apr 8;12:610658. doi: 10.3389/fneur.2021.610658. eCollection 2021.
To investigate the velocity and extent of cortical venous filling (CVF) and its association with clinical manifestations in patients with severe stenosis or occlusion of the middle cerebral artery (MCA) using dynamic computed tomography angiography (CTA). Fifty-eight patients (36 symptomatic and 22 asymptomatic) with severe unilateral stenosis (≥70%) or occlusion of the MCA M1 segment who underwent dynamic CTA were included. Collateral status, antegrade flow, and CVF of each patient were observed using dynamic CTA. Three types of cortical veins were selected to observe the extent of CVF, and the absence of CVF (CVF-) was recorded. Based on the appearance of CVF in the superior sagittal sinus, instances of CVF, including early (CVF), peak (CVF), and late (CVF) venous phases, were recorded. The differences in CVF times between the affected and contralateral hemispheres were represented as rCVFs, and CVF velocity was defined compared to the median time of each rCVF. All CVF times in the affected hemisphere were longer than those in the contralateral hemisphere (p < 0.05). Patients with symptomatic MCA stenosis had more ipsilateral CVF- ( = 0.02) and more delayed CVF at rCVF and rCVF (rCVF-rCVF) ( = 0.03 and 0.001, respectively) compared to those with asymptomatic MCA stenosis. For symptomatic patients, fast CVF at rCVF was associated with poor collateral status (odds ratio [OR] 6.42, 95% confidence interval [CI] 1.37-30.05, = 0.02), and ipsilateral CVF- in two cortical veins was associated with poor 3-month outcomes (adjusted OR 0.025, 95% CI 0.002-0.33, = 0.005). Complete and fast CVF is essential for patients with symptomatic MCA stenosis or occlusion. The clinical value of additional CVF assessment should be explored in future studies to identify patients with severe MCA stenosis or occlusion at a higher risk of stroke occurrence and poor recovery.
利用动态计算机断层血管造影（CTA）研究大脑中动脉（MCA）严重狭窄或闭塞患者的皮质静脉充盈（CVF）速度和程度及其与临床表现的关系。纳入58例接受动态CTA检查的单侧MCA M1段严重狭窄（≥70%）或闭塞的患者（36例有症状，22例无症状）。使用动态CTA观察每位患者的侧支循环状态、顺行血流和CVF。选择三种类型的皮质静脉观察CVF程度，并记录无CVF（CVF-）情况。根据上矢状窦中CVF的表现，记录CVF情况，包括早期（CVF）、峰值（CVF）和晚期（CVF）静脉期。患侧和对侧半球之间CVF时间的差异表示为rCVF，CVF速度与每个rCVF的中位时间进行比较来定义。患侧半球的所有CVF时间均长于对侧半球（p<0.05）。与无症状MCA狭窄患者相比，有症状MCA狭窄患者同侧CVF-更多（=0.02），rCVF和rCVF时CVF延迟更明显（rCVF-rCVF）（分别为=0.03和0.001）。对于有症状的患者，rCVF时快速CVF与侧支循环状态差相关（优势比[OR]6.42，95%置信区间[CI]1.37 - 30.05，=0.02），两条皮质静脉同侧CVF-与3个月预后差相关（校正OR 0.025，95%CI 0.002 - 0.33，=0.005）。完全且快速的CVF对有症状的MCA狭窄或闭塞患者至关重要。未来研究应探索额外CVF评估的临床价值，以识别发生中风风险较高且恢复较差的严重MCA狭窄或闭塞患者。
