Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China.
Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
J Cereb Blood Flow Metab. 2023 Nov;43(2_suppl):106-115. doi: 10.1177/0271678X231165606. Epub 2023 Mar 27.
Unfavorable venous outflow (VO) is associated with cerebral edema, which represents microvascular dysfunction. This study estimated the relationship between VO and microvascular function in acute ischemic stroke patients. We retrospectively included 102 MCA/ICA occluded patients with anterior circulation infarction who underwent reperfusion therapy between July 2017 and April 2022. Unfavorable VO was defined as a cortical vein opacification score of 0-3 and favorable VO as that of 4-6. The clinical characteristics, collateral status, microvascular integrity, and outcomes were compared between patients with favorable and unfavorable VO. Multivariate analysis and receiver operator characteristic (ROC) analysis were used. The patients with unfavorable VO had higher extravascular-extracellular volume fraction (Ve) in the infarct core and a lower percentage of robust arterial collateral circulation. ROC analysis revealed that Ve in the infarct core predicts unfavorable VO (AUC = 0.67, sensitivity = 65.08%, specificity = 69.23%). The higher Ve in the infarct core (odds ratio = 1.011, 95% CI = 1.000-1.021, 0.046) and poor arterial collateral flow (odds ratio = 0.102, 95% CI = 0.032-0.327, < 0.001) were independent predictors of unfavorable VO. This suggests that microvascular dysfunction may be one of the mechanisms underlying impaired VO.
静脉回流（venous outflow，VO）不良与脑水肿有关，脑水肿代表微血管功能障碍。本研究评估了急性缺血性脑卒中患者 VO 与微血管功能之间的关系。我们回顾性纳入了 2017 年 7 月至 2022 年 4 月期间接受再灌注治疗的前循环梗死 MCA/ICA 闭塞的 102 例患者。VO 不良定义为皮质静脉显影评分 0-3 分，VO 良好定义为 4-6 分。比较了 VO 良好和不良患者的临床特征、侧支循环状态、微血管完整性和结局。采用多变量分析和受试者工作特征（receiver operating characteristic，ROC）分析。VO 不良患者梗死核心区血管外细胞外容积分数（extravascular-extracellular volume fraction，Ve）较高，强有力的动脉侧支循环较少。ROC 分析显示，梗死核心区的 Ve 预测 VO 不良（AUC=0.67，敏感度=65.08%，特异度=69.23%）。梗死核心区较高的 Ve（比值比=1.011，95%置信区间=1.000-1.021，0.046）和较差的动脉侧支血流（比值比=0.102，95%置信区间=0.032-0.327，<0.001）是 VO 不良的独立预测因子。这表明微血管功能障碍可能是 VO 受损的机制之一。
