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Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients

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Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients. / Heitkamp, Christian; Winkelmeier, Laurens; Heit, Jeremy J; Albers, Gregory W; Lansberg, Maarten G; Wintermark, Max; Broocks, Gabriel; van Horn, Noel; Kniep, Helge C; Sporns, Peter B; Zeleňák, Kamil; Fiehler, Jens; Faizy, Tobias D.

In: EUR J NEUROL, Vol. 30, No. 9, 09.2023, p. 2684-2692.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Heitkamp, C, Winkelmeier, L, Heit, JJ, Albers, GW, Lansberg, MG, Wintermark, M, Broocks, G, van Horn, N, Kniep, HC, Sporns, PB, Zeleňák, K, Fiehler, J & Faizy, TD 2023, 'Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients', EUR J NEUROL, vol. 30, no. 9, pp. 2684-2692. https://doi.org/10.1111/ene.15898

APA

Heitkamp, C., Winkelmeier, L., Heit, J. J., Albers, G. W., Lansberg, M. G., Wintermark, M., Broocks, G., van Horn, N., Kniep, H. C., Sporns, P. B., Zeleňák, K., Fiehler, J., & Faizy, T. D. (2023). Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients. EUR J NEUROL, 30(9), 2684-2692. https://doi.org/10.1111/ene.15898

Vancouver

Heitkamp C, Winkelmeier L, Heit JJ, Albers GW, Lansberg MG, Wintermark M et al. Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients. EUR J NEUROL. 2023 Sep;30(9):2684-2692. https://doi.org/10.1111/ene.15898

Bibtex

@article{f7fdf10dedf34cf896f69399f73a5901,
title = "Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients",
abstract = "BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) has proven to be the standard of care for patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). However, high revascularization rates do not necessarily result in favorable functional outcomes. We aimed to investigate imaging biomarkers associated with futile recanalization, defined as unfavorable functional outcome despite successful recanalization in AIS-LVO patients.METHODS: A retrospective multicenter cohort study was made of AIS-LVO patients treated by MT. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction score of 2b-3. A modified Rankin Scale score of 3-6 at 90 days was defined as unfavorable functional outcome. Cortical Vein Opacification Score (COVES) was used to assess venous outflow (VO), and the Tan scale was utilized to determine pial arterial collaterals on admission computed tomography angiography (CTA). Unfavorable VO was defined as COVES ≤ 2. Multivariable regression analysis was performed to investigate vascular imaging factors associated with futile recanalization.RESULTS: Among 539 patients in whom successful recanalization was achieved, unfavorable functional outcome was observed in 59% of patients. Fifty-eight percent of patients had unfavorable VO, and 31% exhibited poor pial arterial collaterals. In multivariable regression, unfavorable VO was a strong predictor (adjusted odds ratio = 4.79, 95% confidence interval = 2.48-9.23) of unfavorable functional outcome despite successful recanalization.CONCLUSIONS: We observe that unfavorable VO on admission CTA is a strong predictor of unfavorable functional outcomes despite successful vessel recanalization in AIS-LVO patients. Assessment of VO profiles could help as a pretreatment imaging biomarker to determine patients at risk for futile recanalization.",
keywords = "Humans, Stroke/diagnostic imaging, Ischemic Stroke/complications, Treatment Outcome, Cohort Studies, Cerebral Infarction/complications, Retrospective Studies, Thrombectomy/methods, Brain Ischemia/diagnostic imaging",
author = "Christian Heitkamp and Laurens Winkelmeier and Heit, {Jeremy J} and Albers, {Gregory W} and Lansberg, {Maarten G} and Max Wintermark and Gabriel Broocks and {van Horn}, Noel and Kniep, {Helge C} and Sporns, {Peter B} and Kamil Zele{\v n}{\'a}k and Jens Fiehler and Faizy, {Tobias D}",
note = "{\textcopyright} 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.",
year = "2023",
month = sep,
doi = "10.1111/ene.15898",
language = "English",
volume = "30",
pages = "2684--2692",
journal = "EUR J NEUROL",
issn = "1351-5101",
publisher = "Wiley-Blackwell",
number = "9",

}

RIS

TY - JOUR

T1 - Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients

AU - Heitkamp, Christian

AU - Winkelmeier, Laurens

AU - Heit, Jeremy J

AU - Albers, Gregory W

AU - Lansberg, Maarten G

AU - Wintermark, Max

AU - Broocks, Gabriel

AU - van Horn, Noel

AU - Kniep, Helge C

AU - Sporns, Peter B

AU - Zeleňák, Kamil

AU - Fiehler, Jens

AU - Faizy, Tobias D

N1 - © 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

PY - 2023/9

Y1 - 2023/9

N2 - BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) has proven to be the standard of care for patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). However, high revascularization rates do not necessarily result in favorable functional outcomes. We aimed to investigate imaging biomarkers associated with futile recanalization, defined as unfavorable functional outcome despite successful recanalization in AIS-LVO patients.METHODS: A retrospective multicenter cohort study was made of AIS-LVO patients treated by MT. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction score of 2b-3. A modified Rankin Scale score of 3-6 at 90 days was defined as unfavorable functional outcome. Cortical Vein Opacification Score (COVES) was used to assess venous outflow (VO), and the Tan scale was utilized to determine pial arterial collaterals on admission computed tomography angiography (CTA). Unfavorable VO was defined as COVES ≤ 2. Multivariable regression analysis was performed to investigate vascular imaging factors associated with futile recanalization.RESULTS: Among 539 patients in whom successful recanalization was achieved, unfavorable functional outcome was observed in 59% of patients. Fifty-eight percent of patients had unfavorable VO, and 31% exhibited poor pial arterial collaterals. In multivariable regression, unfavorable VO was a strong predictor (adjusted odds ratio = 4.79, 95% confidence interval = 2.48-9.23) of unfavorable functional outcome despite successful recanalization.CONCLUSIONS: We observe that unfavorable VO on admission CTA is a strong predictor of unfavorable functional outcomes despite successful vessel recanalization in AIS-LVO patients. Assessment of VO profiles could help as a pretreatment imaging biomarker to determine patients at risk for futile recanalization.

AB - BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) has proven to be the standard of care for patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). However, high revascularization rates do not necessarily result in favorable functional outcomes. We aimed to investigate imaging biomarkers associated with futile recanalization, defined as unfavorable functional outcome despite successful recanalization in AIS-LVO patients.METHODS: A retrospective multicenter cohort study was made of AIS-LVO patients treated by MT. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction score of 2b-3. A modified Rankin Scale score of 3-6 at 90 days was defined as unfavorable functional outcome. Cortical Vein Opacification Score (COVES) was used to assess venous outflow (VO), and the Tan scale was utilized to determine pial arterial collaterals on admission computed tomography angiography (CTA). Unfavorable VO was defined as COVES ≤ 2. Multivariable regression analysis was performed to investigate vascular imaging factors associated with futile recanalization.RESULTS: Among 539 patients in whom successful recanalization was achieved, unfavorable functional outcome was observed in 59% of patients. Fifty-eight percent of patients had unfavorable VO, and 31% exhibited poor pial arterial collaterals. In multivariable regression, unfavorable VO was a strong predictor (adjusted odds ratio = 4.79, 95% confidence interval = 2.48-9.23) of unfavorable functional outcome despite successful recanalization.CONCLUSIONS: We observe that unfavorable VO on admission CTA is a strong predictor of unfavorable functional outcomes despite successful vessel recanalization in AIS-LVO patients. Assessment of VO profiles could help as a pretreatment imaging biomarker to determine patients at risk for futile recanalization.

KW - Humans

KW - Stroke/diagnostic imaging

KW - Ischemic Stroke/complications

KW - Treatment Outcome

KW - Cohort Studies

KW - Cerebral Infarction/complications

KW - Retrospective Studies

KW - Thrombectomy/methods

KW - Brain Ischemia/diagnostic imaging

U2 - 10.1111/ene.15898

DO - 10.1111/ene.15898

M3 - SCORING: Journal article

C2 - 37243906

VL - 30

SP - 2684

EP - 2692

JO - EUR J NEUROL

JF - EUR J NEUROL

SN - 1351-5101

IS - 9

ER -