Jiang Shuyu, Gong Chen, Huang Liping, Wang You, Wang Zhiyuan, Chen Yankun, Yuan Jinxian, Wang Li, Gong Siyin, Tan Dandan, Zhang Peng, Huang Yunyi, Wen Yuetao, Hu Yang, Li Zhipeng, Li Wenze, Liu Jin, Guo Jing, Chen Shengli, Chen Yangmei, Xu Tao
Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, China.
J Neurointerv Surg. 2025 Jan 25. doi: 10.1136/jnis-2024-021826.
Favorable venous outflow (VO) has been recognized as an independent predictor of excellent clinical outcomes in acute ischemic stroke caused by anterior circulation large vessel occlusion (AIS-LVO) patients who received endovascular treatment (EVT). However, the reasons why VO affects clinical outcomes have not been fully explained. In this study, we aimed to identify the potential mediators of VO affecting prognosis.
We conducted a multicenter retrospective cohort study of consecutive patients with AIS-LVO who underwent EVT. Baseline computed tomographic angiography (CTA) was applied to assess VO by the Cortical Vein Opacification Score (COVES). The primary outcome was functional independence at 90 days (modified Rankin Scale (mRS) score of 0-2). Classifying subtypes of intracranial hemorrhage (ICH) to explore the relationship between ICH subtypes and VO. Multivariate logistic regression and causal mediation analyses were used to evaluate the relationship among VO, functional independence, and potential mediators.
Among 860 AIS-LVO patients undergoing EVT, a total of 515 patients were included in the present study after strict screening. In multivariate logistic regression analysis, favorable VO profiles (defined as COVES 3-6) were significantly associated with a lower incidence of ICH (24.2% vs 46.9%, adjusted odds ratio (aOR) 0.48, 95% confidence interval (CI) 0.30 to 0.77, P=0.002) and a higher proportion of functional independence (58.9% vs 15.0%, aOR 4.07, 95% CI 2.41 to 6.88, P<0.001). Mediation analysis showed that favorable VO profiles significantly reduced the incidence of parencuymal hematoma (PH) 2 accounting for 8.0% (95% CI 0.9% to 19.0%) of its beneficial effect on functional independence.
This study demonstrated the potential mediating effects of severe ICH for the beneficial effect of favorable VO on clinical prognosis among patients with AIS-LVO who underwent EVT.
良好的静脉流出（VO）已被认为是接受血管内治疗（EVT）的前循环大血管闭塞（AIS-LVO）患者临床预后良好的独立预测因素。然而，VO影响临床预后的原因尚未得到充分解释。在本研究中，我们旨在确定VO影响预后的潜在介导因素。
我们对连续接受EVT的AIS-LVO患者进行了一项多中心回顾性队列研究。应用基线计算机断层血管造影（CTA）通过皮质静脉显影评分（COVES）评估VO。主要结局是90天时的功能独立性（改良Rankin量表（mRS）评分为0-2）。对颅内出血（ICH）亚型进行分类，以探讨ICH亚型与VO之间的关系。采用多变量逻辑回归和因果中介分析来评估VO、功能独立性和潜在介导因素之间的关系。
在860例接受EVT的AIS-LVO患者中，经过严格筛选后，本研究共纳入515例患者。在多变量逻辑回归分析中，良好的VO特征（定义为COVES 3-6）与ICH发生率较低显著相关（24.2%对46.9%，调整优势比（aOR）0.48，95%置信区间（CI）0.30至0.77，P = 0.002）以及功能独立性比例较高显著相关（58.9%对15.0%，aOR 4.07，95%CI 2.41至6.88，P < 0.001）。中介分析表明，良好的VO特征显著降低了脑实质血肿（PH）2的发生率，其对功能独立性的有益作用占8.0%（95%CI 0.9%至19.0%）。
本研究证明了在接受EVT的AIS-LVO患者中，严重ICH对良好VO对临床预后的有益作用具有潜在的中介效应。
