Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400016, China.
Eur Radiol. 2024 Nov;34(11):1-11. doi: 10.1007/s00330-024-10742-3. Epub 2024 May 9.
To investigate the association between venous outflow (VO) profiles and outcomes among acute ischemic stroke caused by anterior circulation large vessel occlusion (AIS-LVO) patients who had undergone endovascular treatment (EVT) in the late window of 6-24 h from stroke onset.
This was a post-hoc analysis of our preceding RESCUE-BT trial, with findings validated in an external cohort. Baseline computed tomographic angiography (CTA) was performed to assess VO using the Cortical Vein Opacification Score (COVES). The primary clinical outcome was functional independence at 90 days (modified Rankin Scale score of 0-2). The adjusted odd ratio (aOR) and confidence interval (CI) were obtained from multivariable logistic regressions.
A total of 440 patients were included in the present study. After identifying the cutoff of COVES by marginal effects approach, enrolled patients were divided into the favorable VO group (COVES 4-6) and the poor VO (COVES 0-3) group. Multivariable logistic regression analysis showed that favorable VO (aOR 2.25; 95% CI 1.31-3.86; p = 0.003) was associated with functional independence. Similar results were detected in the external validation cohort. Among those with poor arterial collateralization, favorable VO was still an independent predictor of functional independence (aOR 2.09; 95% CI 1.06-4.10; p = 0.032).
The robust VO profile indicated by COVES 4-6 could promote the frequency of functional independence among AIS-LVO patients receiving EVT in the late window, and the prognostic value of VO was independent of the arterial collateral status.
The robust venous outflow profile was a valid predictor for functional independence among AIS-LVO patients receiving EVT in the late window (6-24 h) and the predictive role of venous outflow did not rely on the status of arterial collateral circulation.
探讨急性缺血性卒中（AIS）患者血管再通（VO）与结局的相关性，这些患者在卒中发作后 6-24 小时的晚期窗口内接受了血管内治疗（EVT）。
这是对我们之前的 RESCUE-BT 试验的事后分析，结果在外部队列中得到验证。基线计算机断层血管造影（CTA）用于评估 VO，采用皮质静脉显影评分（COVES）。主要临床终点为 90 天的功能独立性（改良 Rankin 量表评分 0-2）。多变量逻辑回归获得调整后的优势比（aOR）和置信区间（CI）。
本研究共纳入 440 例患者。通过边际效应法确定 COVES 截断值后，将纳入的患者分为 VO 良好组（COVES 4-6）和 VO 不良组（COVES 0-3）。多变量逻辑回归分析显示，VO 良好（aOR 2.25；95% CI 1.31-3.86；p=0.003）与功能独立性相关。在外部验证队列中也得到了类似的结果。在动脉侧支循环不良的患者中，VO 良好仍然是功能独立性的独立预测因子（aOR 2.09；95% CI 1.06-4.10；p=0.032）。
COVES 4-6 所示的稳健 VO 模式可提高 AIS-LVO 患者接受晚期 EVT 治疗后的功能独立性频率，而 VO 的预后价值独立于动脉侧支循环状态。
在接受晚期（6-24 小时）EVT 的 AIS-LVO 患者中，VO 良好模式是功能独立性的有效预测因子，而 VO 的预测作用不依赖于动脉侧支循环的状态。
