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09.05.2024 | Vascular-Interventional

The impacts of venous outflow profiles on outcomes among large vessel occlusion patients receiving endovascular treatment in the late window

verfasst von: Chen Gong, Liping Huang, Jiacheng Huang, Liyuan Chen, Weilin Kong, Yangmei Chen, Fengli Li, Chang Liu

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Abstract

Objectives

To investigate the association between venous outflow (VO) profiles and outcomes among acute ischemic stroke caused by anterior circulation large vessel occlusion (AIS-LVO) patients who had undergone endovascular treatment (EVT) in the late window of 6–24 h from stroke onset.

Methods

This was a post-hoc analysis of our preceding RESCUE-BT trial, with findings validated in an external cohort. Baseline computed tomographic angiography (CTA) was performed to assess VO using the Cortical Vein Opacification Score (COVES). The primary clinical outcome was functional independence at 90 days (modified Rankin Scale score of 0–2). The adjusted odd ratio (aOR) and confidence interval (CI) were obtained from multivariable logistic regressions.

Results

A total of 440 patients were included in the present study. After identifying the cutoff of COVES by marginal effects approach, enrolled patients were divided into the favorable VO group (COVES 4–6) and the poor VO (COVES 0–3) group. Multivariable logistic regression analysis showed that favorable VO (aOR 2.25; 95% CI 1.31–3.86; p = 0.003) was associated with functional independence. Similar results were detected in the external validation cohort. Among those with poor arterial collateralization, favorable VO was still an independent predictor of functional independence (aOR 2.09; 95% CI 1.06–4.10; p = 0.032).

Conclusion

The robust VO profile indicated by COVES 4–6 could promote the frequency of functional independence among AIS-LVO patients receiving EVT in the late window, and the prognostic value of VO was independent of the arterial collateral status.

Clinical relevance statement

The robust venous outflow profile was a valid predictor for functional independence among AIS-LVO patients receiving EVT in the late window (6–24 h) and the predictive role of venous outflow did not rely on the status of arterial collateral circulation.

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Powers WJ, Rabinstein AA, Ackerson T et al (2019) Guidelines for the early management of patients with acute ischemic stroke: update to the 2018 guidelines for the early management of acute ischemic: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50:e344–e418. https://doi.org/10.1161/STR.0000000000000211

Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 h after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21. https://doi.org/10.1056/NEJMoa1706442CrossRefPubMed

Albers GW, Marks MP, Kemp S et al (2018) Thrombectomy for stroke at 6 to 16 h with selection by perfusion imaging. N Engl J Med 378:708–718. https://doi.org/10.1056/NEJMoa1713973CrossRefPubMedPubMedCentral

Deng G, Xiao J, Yu H et al (2022) Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis. J Neurointerv Surg 14:881–885. https://doi.org/10.1136/neurintsurg-2021-017963CrossRefPubMed

Berkhemer OA, Jansen IGH, Beumer D et al (2016) Collateral status on baseline computed tomographic angiography and intra-arterial treatment effect in patients with proximal anterior circulation stroke. Stroke 47:768–776. https://doi.org/10.1161/STROKEAHA.115.011788CrossRefPubMed

Menon BK, Qazi E, Nambiar V et al (2015) Differential effect of baseline computed tomographic angiography collaterals on clinical outcome in patients enrolled in the interventional management of stroke III trial. Stroke 46:1239–1244. https://doi.org/10.1161/STROKEAHA.115.009009CrossRefPubMedPubMedCentral

de Havenon A, Mlynash M, Kim-Tenser MA et al (2019) Results from DEFUSE 3: good collaterals are associated with reduced ischemic core growth but not neurologic outcome. Stroke 50:632–638. https://doi.org/10.1161/STROKEAHA.118.023407CrossRefPubMedPubMedCentral

Olthuis SGH, Pirson FAV, Pinckaers FME et al (2023) Endovascular treatment versus no endovascular treatment after 6-24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial. Lancet 401:1371–1380. https://doi.org/10.1016/S0140-6736(23)00575-5CrossRefPubMed

Bhaskar S, Bivard A, Parsons M et al (2017) Delay of late-venous phase cortical vein filling in acute ischemic stroke patients: associations with collateral status. J Cereb Blood Flow Metab 37:671–682. https://doi.org/10.1177/0271678X16637611CrossRefPubMed

10.

Jansen IGH, van Vuuren AB, van Zwam WH et al (2018) Absence of cortical vein opacification is associated with lack of intra-arterial therapy benefit in stroke. Radiology 286:731. https://doi.org/10.1148/radiol.2017174043CrossRefPubMed

11.

Faizy TD, Kabiri R, Christensen S et al (2021) Favorable venous outflow profiles correlate with favorable tissue-level collaterals and clinical outcome. Stroke 52:1761–1767. https://doi.org/10.1161/STROKEAHA.120.032242CrossRefPubMed

12.

Faizy TD, Kabiri R, Christensen S et al (2021) Association of venous outflow profiles and successful vessel reperfusion after thrombectomy. Neurology 96:e2903–e2911. https://doi.org/10.1212/WNL.0000000000012106CrossRefPubMedPubMedCentral

13.

Zachrison KS, Schwamm LH, Xu H et al (2021) Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 h of onset in US clinical practice. Stroke 52:3805–3814. https://doi.org/10.1161/STROKEAHA.121.034069CrossRefPubMed

14.

Li S, Fang S, Zhang D et al (2022) Association between rehabilitation after reperfusion treatment and in-hospital mortality: results from a national registry study. Front Neurol 13:949669. https://doi.org/10.3389/fneur.2022.949669CrossRefPubMedPubMedCentral

15.

RESCUE BT Trial Investigators, Qiu Z, Li F et al (2022) Effect of intravenous tirofiban vs placebo before endovascular thrombectomy on functional outcomes in large vessel occlusion stroke: the rescue BT randomized clinical trial. JAMA 328:543–553. https://doi.org/10.1001/jama.2022.12584CrossRefPubMedCentral

16.

Li X, Lin L, Zhang J et al (2023) Microvascular dysfunction associated with unfavorable venous outflow in acute ischemic stroke patients. J Cereb Blood Flow Metab 271678X231165606. https://doi.org/10.1177/0271678X231165606

17.

Cao R, Jiang Y, Li L et al (2022) Venous collaterals in acute ischemic stroke patients after endovascular treatments: a novel scoring system using 4D computed tomography angiography. Quant Imaging Med Surg 12:5030–5043. https://doi.org/10.21037/qims-22-245CrossRefPubMedPubMedCentral

18.

Lai AYT, Riddell A, Barwick T et al (2020) Interobserver agreement of whole-body magnetic resonance imaging is superior to whole-body computed tomography for assessing disease burden in patients with multiple myeloma. Eur Radiol 30:320–327. https://doi.org/10.1007/s00330-019-06281-xCrossRefPubMed

19.

Benchoufi M, Matzner-Lober E, Molinari N et al (2020) Interobserver agreement issues in radiology. Diagn Interv Imaging 101:639–641. https://doi.org/10.1016/j.diii.2020.09.001CrossRefPubMed

20.

Shu W, Wei L, Yu F et al (2024) Automated ASPECTS calculation may equal the performance of experienced clinicians: a machine learning study based on a large cohort. Eur Radiol 34:1624–1634. https://doi.org/10.1007/s00330-023-10053-zCrossRef

21.

Adams HP, Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41. https://doi.org/10.1161/01.str.24.1.35CrossRefPubMed

22.

Hill MD, Demchuk AM, Goyal M et al (2014) Alberta stroke program early computed tomography score to select patients for endovascular treatment: interventional management of stroke (IMS)-III trial. Stroke 45:444–449. https://doi.org/10.1161/STROKEAHA.113.003580CrossRefPubMed

23.

Yoo AJ, Simonsen CZ, Prabhakaran S et al (2013) Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy. Stroke 44:2509–2512. https://doi.org/10.1161/STROKEAHA.113.001990CrossRefPubMedPubMedCentral

24.

Higashida RT, Furlan AJ, Roberts H et al (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34:e109–e137. https://doi.org/10.1161/01.STR.0000082721.62796.09CrossRefPubMed

25.

von Kummer R, Broderick JP, Campbell BCV et al (2015) The Heidelberg Bleeding Classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 46:2981–2986. https://doi.org/10.1161/STROKEAHA.115.010049CrossRef

26.

Brozici M, van der Zwan A, Hillen B (2003) Anatomy and functionality of leptomeningeal anastomoses: a review. Stroke 34:2750–2762. https://doi.org/10.1161/01.STR.0000095791.85737.65CrossRefPubMed

27.

Liebeskind DS (2005) Collaterals in acute stroke: beyond the clot. Neuroimaging Clin N Am 15:553–573. https://doi.org/10.1016/j.nic.2005.08.012

28.

Zhang X, Peng M, Feng C et al (2021) Nomogram predicting early neurological improvement in ischaemic stroke patients treated with endovascular thrombectomy. Eur J Neurol 28:152–160. https://doi.org/10.1111/ene.14510CrossRefPubMed

29.

Fiehler J, Knudsen K, Thomalla G et al (2005) Vascular occlusion sites determine differences in lesion growth from early apparent diffusion coefficient lesion to final infarct. AJNR Am J Neuroradiol 26:1056–1061PubMedPubMedCentral

30.

Mokin M, Kass-Hout T, Kass-Hout O et al (2012) Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. Stroke 43:2362–2368. https://doi.org/10.1161/STROKEAHA.112.655621CrossRefPubMed

31.

Tei H, Uchiyama S, Usui T, Ohara K (2011) Diffusion-weighted ASPECTS as an independent marker for predicting functional outcome. J Neurol 258:559–565. https://doi.org/10.1007/s00415-010-5787-xCrossRefPubMed

32.

Anadani M, Finitsis S, Clarençon F et al (2022) Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry. J Neurointerv Surg 14:551–557. https://doi.org/10.1136/neurintsurg-2021-017553CrossRefPubMed

33.

Gerber JC, Petrova M, Krukowski P et al (2016) Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients. Brain Behav 6:e00513. https://doi.org/10.1002/brb3.513CrossRefPubMedPubMedCentral

34.

Kim BM, Baek J-H, Heo JH et al (2018) Collateral status affects the onset-to-reperfusion time window for good outcome. J Neurol Neurosurg Psychiatry 89:903–909. https://doi.org/10.1136/jnnp-2017-317627CrossRefPubMed

35.

Winkelmeier L, Heit JJ, Adusumilli G et al (2023) Poor venous outflow profiles increase the risk of reperfusion hemorrhage after endovascular treatment. J Cereb Blood Flow Metab 43:72–83. https://doi.org/10.1177/0271678X221127089CrossRefPubMed

36.

Mangiardi M, Bonura A, Iaccarino G et al (2023) The pathophysiology of collateral circulation in acute ischemic stroke. Diagnostics (Basel) 13:2425. https://doi.org/10.3390/diagnostics13142425CrossRefPubMed

37.

Kim J-T, Goyal M, Levy EI et al (2020) Onset to reperfusion time as a determinant of outcomes across a wide range of ASPECTS in endovascular thrombectomy: pooled analysis of the SWIFT, SWIFT PRIME, and STAR studies. J Neurointerv Surg 12:240–245. https://doi.org/10.1136/neurintsurg-2019-014906CrossRefPubMed

38.

van Horn N, Heit JJ, Kabiri R et al (2022) Cerebral venous outflow profiles are associated with the first pass effect in endovascular thrombectomy. J Neurointerv Surg 14:1056–1061. https://doi.org/10.1136/neurintsurg-2021-018078CrossRefPubMed

39.

Tsai C-F, Anderson N, Thomas B, Sudlow CLM (2015) Risk factors for ischemic stroke and its subtypes in Chinese vs. Caucasians: systematic review and meta-analysis. Int J Stroke 10:485–493. https://doi.org/10.1111/ijs.12508CrossRefPubMed

40.

Sinha A, Stanwell P, Beran RG et al (2021) Stroke Aetiology and collateral status in acute ischemic stroke patients receiving reperfusion therapy-a meta-analysis. Neurol Int 13:608–621. https://doi.org/10.3390/neurolint13040060CrossRefPubMedPubMedCentral

41.

Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428. https://doi.org/10.1037//0033-2909.86.2.420CrossRefPubMed

42.

Leyland, AH, Groenewegen, PP (2023) Intraclass correlation coefficient (ICC). In: Encyclopedia of quality of life and well-being research. Springer, Cham. https://doi.org/10.1007/978-3-031-17299-1_1528

43.

Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163. https://doi.org/10.1016/j.jcm.2016.02.012CrossRefPubMedPubMedCentral

Titel: The impacts of venous outflow profiles on outcomes among large vessel occlusion patients receiving endovascular treatment in the late window
verfasst von: Chen Gong
Liping Huang
Jiacheng Huang
Liyuan Chen
Weilin Kong
Yangmei Chen
Fengli Li
Chang Liu
Publikationsdatum: 09.05.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-024-10742-3

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The impacts of venous outflow profiles on outcomes among large vessel occlusion patients receiving endovascular treatment in the late window

Abstract

Objectives

Methods

Results

Conclusion

Clinical relevance statement

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Update Radiologie

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Objectives

Methods

Results

Conclusion

Clinical relevance statement

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„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

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Darf man die Behandlung eines Neonazis ablehnen?

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

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