Decrease in cortical vein opacification predicts outcome after aneurysmal subarachnoid hemorrhage

William S Dodd; Orrin Dayton; Brandon Lucke-Wold; Christian Reitano; Zachary Sorrentino; Katharina M Busl

doi:10.1136/jnis-2022-019578

Decrease in cortical vein opacification predicts outcome after aneurysmal subarachnoid hemorrhage

J Neurointerv Surg. 2023 Nov;15(11):1105-1110. doi: 10.1136/jnis-2022-019578. Epub 2022 Dec 1.

Authors

William S Dodd¹, Orrin Dayton², Brandon Lucke-Wold³, Christian Reitano², Zachary Sorrentino³, Katharina M Busl^{4

5}

Affiliations

¹ College of Medicine, University of Florida, Gainesville, Florida, USA.
² Department of Radiology, University of Florida, Gainesville, Florida, USA.
³ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
⁴ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA katharina.busl@neurology.ufl.edu.
⁵ Department of Neurology, University of Florida, Gainesville, Florida, USA.

PMID: 36456184
DOI: 10.1136/jnis-2022-019578

Abstract

Background: The pathophysiology of brain injury after aneurysmal subarachnoid hemorrhage (aSAH) remains incompletely understood. Cerebral venous flow patterns may be a marker of hemodynamic disruptions after aneurysm rupture. We hypothesized that a decrease in venous filling after aSAH would predict cerebral ischemia and poor outcome.

Objective: To examine the hypotheses that venous filling as measured by the cortical venous opacification score (COVES) would (1) decrease after aSAH and (2) that decreased COVES would be associated with higher rates of hydrocephalus, vasospasm, delayed cerebral iscemia (DCI), and poor functional evaluation at outcome.

Methods: In this retrospective observational cohort study of consecutive patients with aSAH admitted to our tertiary care center between 2016 and 2018, we measured the COVES at admission and at subsequent CT angiography (CTA). We collected clinical variables and compared hydrocephalus, vasospasm, DCI, and outcome at discharge in patients with decrease in COVES with patients with stable COVES.

Results: A total of 22 patients were included in the analysis. COVES decreased from first CTA to second CTA in 11 (50%) patients, by an average of 1.1 points (P=0.01). Patients whose COVES decreased between admission and follow-up imaging were more likely to develop DCI (58% vs 0%, P=0.03) and have a poor outcome at discharge (100% vs 55%, P=0.03) than patients who had no change in COVES. aSAH severity was not associated with initial COVES, and there was no association between change in COVES and development of hydrocephalus or vasospasm.

Conclusions: Development of decreased venous filling on CTA is associated with poor outcome after aSAH. This association suggests that venous hemodynamics may be reflective of, or contribute to, the pathophysiological mechanisms of brain injury after aSAH. Larger prospective studies are necessary to substantiate our findings.

Keywords: CT Angiography; Hemorrhage; Stroke; Vein.