Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
Int J Stroke. 2022 Dec;17(10):1078-1084. doi: 10.1177/17474930211065635. Epub 2022 Jan 5.
In patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO), development of extensive early ischemic brain edema is associated with poor functional outcomes, despite timely treatment. Robust cortical venous outflow (VO) profiles correlate with favorable tissue perfusion. We hypothesized that favorable VO profiles (VO+) correlate with a reduced early edema progression rate (EPR) and good functional outcomes.
Multicenter, retrospective analysis to investigate AIS-LVO patients treated by mechanical thrombectomy between May 2013 and December 2020. Baseline computed tomography angiography (CTA) was used to determine VO using the cortical vein opacification score (COVES); VO+ was defined as COVES ⩾ 3 and unfavorable as COVES ⩽ 2. EPR was determined as the ratio of net water uptake (NWU) on baseline non-contrast CT and time from symptom onset to admission imaging. Multivariable regression analysis was performed to assess primary (EPR) and secondary outcome (good functional outcomes defined as 0-2 points on the modified Rankin scale).
A total of 728 patients were included. Primary outcome analysis showed VO+ (β: -0.03, : 0.009, = 0.002), lower presentation National Institutes of Health Stroke Scale (NIHSS; β: 0.002, : 0.001, = 0.002), and decreased time from onset to admission imaging (β: -0.00002, : 0.00004, < 0.001) were independently associated with reduced EPR. VO+ also predicted good functional outcomes (odds ratio (OR): 5.07, 95% CI: 2.839-9.039, < 0.001), while controlling for presentation NIHSS, time from onset to imaging, general vessel reperfusion, baseline Alberta Stroke Program Early CT Score, infarct core volume, EPR, and favorable arterial collaterals.
Favorable VO profiles were associated with slower infarct edema progression and good long-term functional outcomes as well as better neurological status and ischemic brain alterations at admission.
在因大血管闭塞（AIS-LVO）导致的急性缺血性脑卒中患者中，尽管进行了及时治疗，但广泛的早期缺血性脑水肿的发展与不良的功能结局相关。强有力的皮质静脉流出（VO）模式与良好的组织灌注相关。我们假设有利的 VO 模式（VO+）与早期水肿进展率（EPR）降低和良好的功能结局相关。
多中心回顾性分析，纳入 2013 年 5 月至 2020 年 12 月接受机械取栓治疗的 AIS-LVO 患者。使用皮质静脉显影评分（COVES）在基线计算机断层血管造影（CTA）上确定 VO；VO+定义为 COVES≥3，而不利的 VO 定义为 COVES≤2。EPR 通过基线非对比 CT 上的净水分摄取（NWU）与从症状发作到入院影像学的时间之比确定。采用多变量回归分析评估主要（EPR）和次要结局（改良后的 Rankin 量表评分为 0-2 分定义为良好的功能结局）。
共纳入 728 例患者。主要结局分析显示 VO+（β：-0.03，：0.009， = 0.002）、较低的发病时国立卫生研究院卒中量表（NIHSS；β：0.002，：0.001， = 0.002）和从发病到入院影像学的时间缩短（β：-0.00002，：0.00004， < 0.001）与 EPR 降低独立相关。VO+还预测了良好的功能结局（优势比（OR）：5.07，95%置信区间：2.839-9.039， < 0.001），同时控制了发病时 NIHSS、从发病到影像学的时间、总血管再通、基线阿尔伯塔卒中项目早期 CT 评分、梗死核心体积、EPR 和有利的动脉侧支循环。
有利的 VO 模式与梗死性脑水肿进展较慢以及良好的长期功能结局相关，并且与入院时的神经功能状态和缺血性脑改变更好相关。
