Data from: Association of venous outflow profiles and successful vessel reperfusion after thrombectomy

Background and Purpose: Robust arterial collaterals are associated with
successful reperfusion after thrombectomy treatment of acute ischemic
stroke due to large vessel occlusion (AIS-LVO). Excellent venous outflow
(VO) reflects excellent tissue perfusion and collateral status in AIS-LVO
patients. Objective: To determine whether favorable VO profiles assessed
on pre-treatment CT angiography (CTA) images correlate with successful
vessel reperfusion after thrombectomy in AIS-LVO patients. Materials and
Methods: Multicenter retrospective cohort study of consecutive AIS-LVO
patients treated by thrombectomy. Baseline CTA was used to assess
collateral status (Tan scale) and VO using the cortical vein opacification
score (COVES). Favorable VO was defined as COVES ≥3. Primary outcome was
excellent vessel reperfusion status (modified Thrombolysis In Cerebral
Infarction [TICI] 2c-3). Secondary outcome was good functional outcome
defined as 0-2 on the Modified Ranking Scale (mRS) after 90 days. Results:
565 patients met inclusion criteria. Multivariable logistic regression
analysis showed that favorable VO (OR= 2.10 [95% CI 1.39-3.16];
p<0.001) was associated with excellent vessel reperfusion during
thrombectomy, regardless of good CTA collateral status (OR= 0.87 [95%CI
0.58-1.34]; p=0.48). A favorable VO profile (OR= 8.9 [95%CI 5.3-14.9];
p<0.001) and excellent vessel reperfusion status (OR = 2.7 [95%CI
1.7-4.4]; p<0.001) were independently associated with good
functional outcome adjusted for age, sex, glucose, tPA administration,
good CTA collateral status and presentation NIHSS. Conclusion: A favorable
VO profile is associated with reperfusion success and good functional
outcomes in patients with AIS-LVO treated by endovascular thrombectomy.

背景与目的：稳定充足的动脉侧支循环与大血管闭塞性急性缺血性脑卒中（AIS-LVO）患者接受血管内取栓术后的成功血管再通密切相关。良好的静脉流出（VO）状态可反映AIS-LVO患者的组织灌注水平与侧支循环情况。本研究旨在明确：接受治疗前CT血管造影（CTA）评估的良好静脉流出表型，是否与AIS-LVO患者血管内取栓术后的成功血管再通存在相关性。
材料与方法：本研究为多中心回顾性队列研究，纳入连续收治的接受血管内取栓术治疗的AIS-LVO患者。采用基线CTA评估侧支循环状态（Tan量表），并通过皮质静脉显影评分（COVES）评估VO情况。将良好VO定义为COVES≥3分。主要结局指标为优良血管再通状态，即脑梗死溶栓改良分级（TICI）2c~3级；次要结局指标为术后90天时改良Rankin量表（mRS）评分0~2分的良好功能预后。
结果：本研究共纳入565名符合纳入标准的患者。多因素logistic回归分析显示，无论CTA侧支循环状态是否良好（比值比[OR]=0.87，95%置信区间[CI]：0.58~1.34；P=0.48），良好VO表型（OR=2.10，95%CI：1.39~3.16；P<0.001）均与取栓术中的优良血管再通显著相关。在校正年龄、性别、血糖水平、组织型纤溶酶原激活剂（tPA）给药情况、CTA侧支循环状态以及入院时美国国立卫生研究院卒中量表（NIHSS）评分后，良好VO表型（OR=8.9，95%CI：5.3~14.9；P<0.001）与优良血管再通状态（OR=2.7，95%CI：1.7~4.4；P<0.001）均为良好功能预后的独立相关因素。
结论：对于接受血管内取栓术治疗的AIS-LVO患者，良好的静脉流出表型与手术再通成功及术后良好功能预后均显著相关。