Asymmetrical Cortical Vein Sign Predicts Early Neurological Deterioration in Acute Ischemic Stroke Patients with Severe Intracranial Arterial Stenosis or Occlusion

Abstract

Background: Susceptibility weighted imaging (SWI) provides a rough assessment of tissue perfusion with the prominent hypointense cortical veins in the ischemic territory due to increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO).Results: One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) increasement≧2 points despite standard treatment in the first 72h after admission. APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P=0.001). Patient with APCVS were more likely to have END (40.0%, vs. 12.2%, P=0.001), in comparation with those without END. Multivariate logistic regression indicated that APCVS (OR=4.349, 95% C.I.=1.580-11.970, P=0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume.Conclusions: In acute ischemic stroke patients with SIASO, APCVS might be a useful neuroimaging marker for predicting END, suggesting the importance of evaluation of perfusion status.