Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy
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Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy. / Faizy, Tobias Djamsched; Kabiri, Reza; Christensen, Soren; Mlynash, Michael; Kuraitis, Gabriella; Mader, Marius Marc-Daniel; Albers, Gregory W; Lansberg, Maarten G; Fiehler, Jens; Wintermark, Max; Marks, Michael P; Heit, Jeremy J.
In: NEUROLOGY, Vol. 96, No. 24, 14.06.2021, p. e2903-e2911.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy
AU - Faizy, Tobias Djamsched
AU - Kabiri, Reza
AU - Christensen, Soren
AU - Mlynash, Michael
AU - Kuraitis, Gabriella
AU - Mader, Marius Marc-Daniel
AU - Albers, Gregory W
AU - Lansberg, Maarten G
AU - Fiehler, Jens
AU - Wintermark, Max
AU - Marks, Michael P
AU - Heit, Jeremy J
N1 - © 2021 American Academy of Neurology.
PY - 2021/6/14
Y1 - 2021/6/14
N2 - OBJECTIVE: 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 patients with AIS-LVO. The goal of this study was to determine whether favorable VO profiles assessed on pretreatment CT angiography (CTA) images correlate with successful vessel reperfusion after thrombectomy in patients with AIS-LVO.METHODS: This was a multicenter retrospective cohort study of consecutive patients with AIS-LVO 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 2c/3). Secondary outcome was good functional outcome defined as a score of 0 to 2 on the modified Rankin Scale after 90 days.RESULTS: Five hundred sixty-five patients met the inclusion criteria. Multivariable logistic regression analysis showed that favorable VO (odds ratio [OR] 2.10 [95% confidence interval (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, tissue plasminogen activator administration, good CTA collateral status, and presentation NIH Stroke Scale score.CONCLUSION: A favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that a favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.
AB - OBJECTIVE: 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 patients with AIS-LVO. The goal of this study was to determine whether favorable VO profiles assessed on pretreatment CT angiography (CTA) images correlate with successful vessel reperfusion after thrombectomy in patients with AIS-LVO.METHODS: This was a multicenter retrospective cohort study of consecutive patients with AIS-LVO 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 2c/3). Secondary outcome was good functional outcome defined as a score of 0 to 2 on the modified Rankin Scale after 90 days.RESULTS: Five hundred sixty-five patients met the inclusion criteria. Multivariable logistic regression analysis showed that favorable VO (odds ratio [OR] 2.10 [95% confidence interval (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, tissue plasminogen activator administration, good CTA collateral status, and presentation NIH Stroke Scale score.CONCLUSION: A favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that a favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.
U2 - 10.1212/WNL.0000000000012106
DO - 10.1212/WNL.0000000000012106
M3 - SCORING: Journal article
C2 - 33952649
VL - 96
SP - e2903-e2911
JO - NEUROLOGY
JF - NEUROLOGY
SN - 0028-3878
IS - 24
ER -
