The negative effect of aging on cerebral venous outflow in acute ischemic stroke
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The negative effect of aging on cerebral venous outflow in acute ischemic stroke. / Heitkamp, Christian; Winkelmeier, Laurens; Heit, Jeremy J; Flottmann, Fabian; Thaler, Christian; Kniep, Helge; Broocks, Gabriel; Meyer, Lukas; Geest, Vincent; Albers, Gregory W; Lansberg, Maarten G; Fiehler, Jens; Faizy, Tobias D.
in: J CEREBR BLOOD F MET, Jahrgang 43, Nr. 10, 10.2023, S. 1648-1655.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - The negative effect of aging on cerebral venous outflow in acute ischemic stroke
AU - Heitkamp, Christian
AU - Winkelmeier, Laurens
AU - Heit, Jeremy J
AU - Flottmann, Fabian
AU - Thaler, Christian
AU - Kniep, Helge
AU - Broocks, Gabriel
AU - Meyer, Lukas
AU - Geest, Vincent
AU - Albers, Gregory W
AU - Lansberg, Maarten G
AU - Fiehler, Jens
AU - Faizy, Tobias D
PY - 2023/10
Y1 - 2023/10
N2 - Cortical venous outflow (VO) represents an imaging biomarker of increasing interest in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). We conducted a retrospective multicenter cohort study to investigate the effect of aging on VO. A total of 784 patients met the inclusion criteria. Cortical Vein Opacification Score (COVES) was used to assess VO profiles on admission CT angiography. Cerebral microperfusion was determined using the hypoperfusion intensity ratio (HIR) derived from perfusion imaging. Arterial collaterals were assessed using the Tan scale. Multivariable regression analysis was performed to identify independent determinants of VO, HIR and arterial collaterals. In multivariable regression, higher age correlated with worse VO (adjusted odds ratio [95% CI]; 0.83 [0.73-0.95]; P = 0.006) and poorer HIR (β coefficient [95% CI], 0.014 [0.005-0.024]; P = 0.002). The negative effect of higher age on VO was mediated by the extent of HIR (17.3%). We conclude that higher age was associated with worse VO in AIS-LVO, partially explained by the extent of HIR reflecting cerebral microperfusion. Our study underlines the need to assess collateral blood flow beyond the arterial system and provides valuable insights into deteriorated cerebral blood supply in elderly AIS-LVO patients.
AB - Cortical venous outflow (VO) represents an imaging biomarker of increasing interest in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). We conducted a retrospective multicenter cohort study to investigate the effect of aging on VO. A total of 784 patients met the inclusion criteria. Cortical Vein Opacification Score (COVES) was used to assess VO profiles on admission CT angiography. Cerebral microperfusion was determined using the hypoperfusion intensity ratio (HIR) derived from perfusion imaging. Arterial collaterals were assessed using the Tan scale. Multivariable regression analysis was performed to identify independent determinants of VO, HIR and arterial collaterals. In multivariable regression, higher age correlated with worse VO (adjusted odds ratio [95% CI]; 0.83 [0.73-0.95]; P = 0.006) and poorer HIR (β coefficient [95% CI], 0.014 [0.005-0.024]; P = 0.002). The negative effect of higher age on VO was mediated by the extent of HIR (17.3%). We conclude that higher age was associated with worse VO in AIS-LVO, partially explained by the extent of HIR reflecting cerebral microperfusion. Our study underlines the need to assess collateral blood flow beyond the arterial system and provides valuable insights into deteriorated cerebral blood supply in elderly AIS-LVO patients.
KW - Humans
KW - Aged
KW - Stroke/diagnostic imaging
KW - Ischemic Stroke
KW - Cohort Studies
KW - Aging
KW - Cerebral Veins/diagnostic imaging
KW - Retrospective Studies
KW - Brain Ischemia/diagnostic imaging
KW - Cerebral Angiography/methods
U2 - 10.1177/0271678X231179558
DO - 10.1177/0271678X231179558
M3 - SCORING: Journal article
C2 - 37254736
VL - 43
SP - 1648
EP - 1655
JO - J CEREBR BLOOD F MET
JF - J CEREBR BLOOD F MET
SN - 0271-678X
IS - 10
ER -