Synchronous Superficial Middle Cerebral Vein Outflow Correlates Favorable Tissue Fate After Mechanical Thrombectomy for Acute Ischemic Stroke

Lisong Dai; Zheng Sun; Jingxuan Jiang; Jianyong Wei; Xinyu Song; Shen Chen; Yuehua Li

doi:10.1016/j.acra.2023.07.005

Synchronous Superficial Middle Cerebral Vein Outflow Correlates Favorable Tissue Fate After Mechanical Thrombectomy for Acute Ischemic Stroke

Acad Radiol. 2024 Apr;31(4):1548-1557. doi: 10.1016/j.acra.2023.07.005. Epub 2023 Aug 3.

Authors

Lisong Dai¹, Zheng Sun¹, Jingxuan Jiang², Jianyong Wei³, Xinyu Song¹, Shen Chen¹, Yuehua Li⁴

Affiliations

¹ Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.).
² Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.); Department of Radiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China (J.J.).
³ Clinical Research Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (J.W.).
⁴ Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China (L.D., Z.S., J.J., X.S., S.C., Y.L.). Electronic address: liyuehua312@163.com.

PMID: 37541827
DOI: 10.1016/j.acra.2023.07.005

Abstract

Rationale and objectives: The purpose of this study was to determine the association between hemispheric synchrony in venous outflow at baseline and tissue fate after mechanical thrombectomy (MT) for acute ischemic stroke (AIS).

Materials and methods: A two-center retrospective analysis involving AIS patients who underwent MT was performed. The four cortical veins of interest include the superficial middle cerebral vein (SMCV), sphenoparietal sinus (SS), vein of Labbé (VOL), and vein of Trolard (VOT). Baseline computed tomography perfusion data were used to compare the following outflow parameters between the hemispheres: first filling time (△FFT), time to peak (△TTP) and total filling time (△TFT). Synchronous venous outflow was defined as △FFT = 0. Multivariable regression analyses were performed to evaluate the association of venous outflow synchrony with penumbral salvage, infarct growth, and intracranial hemorrhage (ICH) after MT.

Results: A total of 151 patients (71.4 ± 13.2 years, 65.6% women) were evaluated. Patients with synchronous SMCV outflow demonstrated significantly greater penumbral salvage (41.3 mL vs. 33.1 mL, P = 0.005) and lower infarct growth (9.0 mL vs. 14.4 mL, P = 0.015) compared to those with delayed SMCV outflow. Higher △FFT_SMCV (β = -1.44, P = 0.013) and △TTP_SMCV (β = -0.996, P = 0.003) significantly associated with lower penumbral salvage, while higher △FFT_SMCV significantly associated with larger infarct growth (β = 1.09, P = 0.005) and increased risk of ICH (odds ratio [OR] = 1.519, P = 0.047).

Conclusion: Synchronous SMCV outflow is an independent predictor of favorable tissue outcome and low ICH risk, and thereby carries the potential as an auxiliary radiological marker aiding the treatment planning of AIS patients.

Keywords: Brain infarction; Cerebrovascular circulation; Perfusion imaging; Thrombectomy; X-ray computed tomography.

MeSH terms

Brain Ischemia* / diagnostic imaging
Brain Ischemia* / etiology
Brain Ischemia* / surgery
Cerebral Veins* / diagnostic imaging
Cerebral Veins* / surgery
Female
Humans
Infarction / etiology
Ischemic Stroke* / etiology
Male
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / etiology
Stroke* / surgery
Thrombectomy / methods
Treatment Outcome