Absence of Cortical Vein Opacification is Associated with Lack of Intra-arterial Therapy Benefit in Stroke

Jansen, Ivo G. H.; Vuuren, Annemieke B. van; Zwam, Wim H. van; Wijngaard, Ido R. van den; Berkhemer, Olvert A.; Lingsma, Hester F.; Slump, Cornelis H.; Oostenbrugge, Robert J. van; Treurniet, Kilian M.; Dippel, Diederik W.J.; Walderveen, Marianne A.A. van; Lugt, Aad van der; Roos, Yvo B.W.E.M.; Marquering, Henk A.; Majoie, Charles B. L. M.; Berg, René van den

doi:10.1148/radiol.2017174043

Cited by 25 publications

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“…Our results are consistent with Jansen et al [6], who found that DVO patients exhibit a favorable COVES profile of ≥1 compared to patients with PVO. However, this study [6] did not measure TLC, and additional study is warranted to determine the optimal COVES threshold that best predicts VO.…”

Section: Discussionsupporting

confidence: 93%

“…These findings indicate that the exact ACL governs cerebral microvascular perfusion. The strong association between DVO and favorable TLC and VO profiles supports the hypothesis that blood that is able to reach the ischemic brain tissue is more likely to exit the brain effectively [3,6,8,14]. Our results are consistent with Jansen et al [6], who found that DVO patients exhibit a favorable COVES profile of ≥1 compared to patients with PVO.…”

Section: Discussionsupporting

confidence: 92%

“…The association of favorable TLCs and VO profiles with a robust CTA collateral profile suggests that arterial collaterals deliver blood to ischemic brain effectively, which then facilitates blood transit through the tissue and into the draining veins [6,9]. However, although most PVO patients exhibited good CTA collaterals (63%), not all of these patients had favorable TLC (39%) and VO (19%) profiles.…”

Section: Discussionmentioning

confidence: 99%

“…However, there was not a consistent correlation between TLC and ACL in patients with poor arterial collaterals. We hypothesize that collateral blood flow through ischemic brain tissue is variably influenced by autoregulation, edema, or other mechanisms, which might account for these differences [6,[14][15][16]. anatomy are relevant for infarct progression [17].…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral perfusion is governed not only by the inflow of arterial blood to the brain tissue but also by its outflow into the cerebral veins [1]. Unhampered venous drainage correlates with robust collateral blood flow and indicates robust cerebral blood flow through brain tissue [1,[5][6][7]. To date, most studies have investigated the impact of distinct arterial clot localization (ACL) on microvascular perfusion by assessing collateral profiles on CTA, but the importance of TLC and cortical venous outflow (VO) in that context is less well understood [8].…”

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confidence: 99%

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Distinct intra‐arterial clot localization affects tissue‐level collaterals and venous outflow profiles

Faizy

Kabiri

Christensen

et al. 2021

Euro J of Neurology

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Background and purpose Arterial clot localization affects collateral flow to ischemic brain in patients with acute ischemic stroke due to large vessel occlusion (AIS‐LVO). We determined the association between vessel occlusion locations, tissue‐level collaterals (TLC), and venous outflow (VO) profiles and their impact on good functional outcomes. Methods We conducted a multicenter retrospective cohort study of consecutive AIS‐LVO patients who underwent thrombectomy triage. Baseline computed tomographic angiography (CTA) was used to localize vessel occlusion, which was dichotomized into proximal vessel occlusion (PVO; internal carotid artery and proximal first segment of the middle cerebral artery [M1]) and distal vessel occlusion (DVO; distal M1 and M2), and to assess collateral scores. TLC were assessed on computed tomographic perfusion data using the hypoperfusion intensity ratio. VO was determined on baseline CTA by the cortical vein opacification score. Primary outcomes were favorable VO and TLC; secondary outcome was the modified Rankin Scale after 90 days. Results A total of 649 patients met inclusion criteria. Of these, 376 patients (58%) had a PVO and 273 patients (42%) had a DVO. Multivariate ordinal logistic regression showed that DVO predicted favorable TLC (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.24–2.52, p = 0.002) and favorable VO (OR = 7.2, 95% CI = 5.2–11.9, p < 0.001). DVO (OR = 3.4, 95% CI = 2.1–5.6, p < 0.001), favorable VO (OR = 6.4, 95% CI = 3.8–10.6, p < 0.001), and favorable TLC (OR = 3.2, 95% CI = 2–5.3, p < 0.001), but not CTA collaterals (OR = 1.07, 95% CI = 0.60–1.91, p = 0.813), were predictors of good functional outcome. Conclusions DVO in AIS‐LVO patients correlates with favorable TLC and VO profiles, which are associated with good functional outcome.

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Section: Discussionsupporting

confidence: 93%