Venous Flow Profiles on Perfusion CT are Associated with Futile Recanalization After Thrombectomy

Mouxiao Su; Zhonglun Chen; Xinyue Chen; Jiaxing Huang; Zhaokun Li; Ying Zhou; Gelin Xu

doi:10.2147/NDT.S360626

Venous Flow Profiles on Perfusion CT are Associated with Futile Recanalization After Thrombectomy

Neuropsychiatr Dis Treat. 2022 Apr 29:18:933-942. doi: 10.2147/NDT.S360626. eCollection 2022.

Authors

Mouxiao Su^{1

2}, Zhonglun Chen², Xinyue Chen³, Jiaxing Huang⁴, Zhaokun Li², Ying Zhou⁴, Gelin Xu^{1

5}

Affiliations

¹ The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, People's Republic of China.
² Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, People's Republic of China.
³ CT Collaboration, Siemens Healthineers, Chengdu, 610000, People's Republic of China.
⁴ Department of Radiology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, People's Republic of China.
⁵ Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People's Republic of China.

Abstract

Background and purpose: Robust venous outflow (VO) reflects favourable tissue reperfusion in acute ischaemic stroke (AIS) patients with large vessel occlusion (LVO). We aimed to investigate the association of the venous outflow profile on computed tomographic perfusion (CTP) and futile recanalization in anterior circulation AIS patients with LVO after thrombectomy.

Methods: This was a retrospective study of consecutive AIS patients due to anterior circulation LVO who underwent CTP before thrombectomy. Patients who achieved successful recanalization defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3 after thrombectomy were included. Based on the venous time-intensity curve of CTP, the peak time of venous outflow (PTV), total venous outflow time (TVT), and difference value of arteriovenous peak time (D-value) were recorded. A modified mRS score of 3-6 at 3 months was regarded as futile recanalization (FR). Logistic regression analysis was applied to assess risk factors for FR. We used receiver operating characteristic curves (ROCs) to evaluate the predictive value of venous outflow time parameters based on VO for FR.

Results: Eighty patients were included; 35 (43.8%) achieved good functional outcomes, and 45 (56.3%) had unfavourable functional outcomes, that is, FR. Adjusting confounding factors, binary stepwise logistic regression analysis showed that delayed PTV was independently associated with FR (odds ratio, 1.374 [95% CI, 1.093-1.726], P = 0.007). ROCs indicated that PTV effectively predicted unfavourable outcomes at 3 months (area under the curve (AUC) = 0.729, p< 0.001). The combined model was a powerful predictor of FR with an AUC of 0.824 and a cut-off value of 0.631 (p< 0.001).

Conclusion: Delayed PTV is independently related to FR in anterior circulation AIS patients with LVO achieving successful recanalization after thrombectomy. Our results highlight that the time of VO may be a potential marker for FR.

Keywords: computed tomographic perfusion; futile recanalization; thrombectomy; time intensity curve.