Faizy Tobias Djamsched, Kabiri Reza, Christensen Soren, Mlynash Michael, Kuraitis Gabriella, Mader Marius Marc-Daniel, Albers Gregory W, Lansberg Maarten G, Fiehler Jens, Wintermark Max, Marks Michael P, Heit Jeremy J
From the Department of Neuroimaging and Neurointerventions (T.D.F., R.K., G.K., M.W., M.P.M., J.J.H.) and Stanford Stroke Center (S.C., M.M., G.W.A., M.G.L.), Stanford University, CA; and Departments of Neurosurgery (M.M.-D.M.) and Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Neurology. 2021 Jun 14;96(24):e2903-e2911. doi: 10.1212/WNL.0000000000012106.
Robust arterial collaterals are associated with successful reperfusion after thrombectomy treatment of acute ischemic stroke due to large vessel occlusion (AIS-LVO). Excellent venous outflow (VO) reflects excellent tissue perfusion and collateral status in patients with AIS-LVO. The goal of this study was to determine whether favorable VO profiles assessed on pretreatment CT angiography (CTA) images correlate with successful vessel reperfusion after thrombectomy in patients with AIS-LVO.
This was a multicenter retrospective cohort study of consecutive patients with AIS-LVO treated by thrombectomy. Baseline CTA was used to assess collateral status (Tan scale) and VO using the Cortical Vein Opacification Score (COVES). Favorable VO was defined as COVES ≥3. Primary outcome was excellent vessel reperfusion status (modified Thrombolysis in Cerebral Infarction 2c/3). Secondary outcome was good functional outcome defined as a score of 0 to 2 on the modified Rankin Scale after 90 days.
Five hundred sixty-five patients met the inclusion criteria. Multivariable logistic regression analysis showed that favorable VO (odds ratio [OR] 2.10 [95% confidence interval (CI) 1.39-3.16]; < 0.001) was associated with excellent vessel reperfusion during thrombectomy, regardless of good CTA collateral status (OR 0.87 [95% CI 0.58-1.34]; = 0.48). A favorable VO profile (OR 8.9 [95%CI 5.3-14.9]; < 0.001) and excellent vessel reperfusion status (OR 2.7 [95%CI 1.7-4.4]; < 0.001) were independently associated with good functional outcome adjusted for age, sex, glucose, tissue plasminogen activator administration, good CTA collateral status, and presentation NIH Stroke Scale score.
A favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.
This study provides Class II evidence that a favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.
强大的动脉侧支循环与因大血管闭塞（AIS-LVO）导致的急性缺血性卒中患者血栓切除术后的成功再灌注相关。良好的静脉流出（VO）反映了AIS-LVO患者的良好组织灌注和侧支循环状态。本研究的目的是确定在治疗前CT血管造影（CTA）图像上评估的良好VO特征是否与AIS-LVO患者血栓切除术后的血管成功再灌注相关。
这是一项对接受血栓切除术治疗的连续AIS-LVO患者进行的多中心回顾性队列研究。使用基线CTA通过皮质静脉显影评分（COVES）评估侧支循环状态（Tan分级）和VO。良好的VO定义为COVES≥3。主要结局是良好的血管再灌注状态（改良脑梗死溶栓2c/3级）。次要结局是良好的功能结局，定义为90天后改良Rankin量表评分为0至2分。
565例患者符合纳入标准。多变量逻辑回归分析显示，良好的VO（比值比[OR]2.10[95%置信区间（CI）1.39-3.16]；P<0.001）与血栓切除术中良好的血管再灌注相关，无论CTA侧支循环状态如何（OR 0.87[95%CI 0.58-1.34]；P = 0.48）。在根据年龄、性别、血糖、组织纤溶酶原激活剂使用、良好的CTA侧支循环状态和就诊时美国国立卫生研究院卒中量表评分进行调整后，良好的VO特征（OR 8.9[95%CI 5.3-14.9]；P<0.001）和良好的血管再灌注状态（OR 2.7[95%CI 1.7-4.4]；P<0.001）与良好的功能结局独立相关。
在接受血管内血栓切除术治疗的AIS-LVO患者中，良好的VO特征与再灌注成功和良好的功能结局相关。
本研究提供了II类证据，表明在接受血管内血栓切除术治疗的AIS-LVO患者中，良好的VO特征与再灌注成功和良好的功能结局相关。
