Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy

Tobias Djamsched Faizy; Reza Kabiri; Soren Christensen; Michael Mlynash; Gabriella Kuraitis; Marius Marc-Daniel Mader; Gregory W Albers; Maarten G Lansberg; Jens Fiehler; Max Wintermark; Michael P Marks; Jeremy J Heit

doi:10.1212/WNL.0000000000012106

Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy

Neurology. 2021 Jun 14;96(24):e2903-e2911. doi: 10.1212/WNL.0000000000012106.

Affiliations

¹ From the Department of Neuroimaging and Neurointerventions (T.D.F., R.K., G.K., M.W., M.P.M., J.J.H.) and Stanford Stroke Center (S.C., M.M., G.W.A., M.G.L.), Stanford University, CA; and Departments of Neurosurgery (M.M.-D.M.) and Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² From the Department of Neuroimaging and Neurointerventions (T.D.F., R.K., G.K., M.W., M.P.M., J.J.H.) and Stanford Stroke Center (S.C., M.M., G.W.A., M.G.L.), Stanford University, CA; and Departments of Neurosurgery (M.M.-D.M.) and Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany. jheit@stanford.edu.

Abstract

Objective: Robust arterial collaterals are associated with successful reperfusion after thrombectomy treatment of acute ischemic stroke due to large vessel occlusion (AIS-LVO). Excellent venous outflow (VO) reflects excellent tissue perfusion and collateral status in patients with AIS-LVO. The goal of this study was to determine whether favorable VO profiles assessed on pretreatment CT angiography (CTA) images correlate with successful vessel reperfusion after thrombectomy in patients with AIS-LVO.

Methods: This was a multicenter retrospective cohort study of consecutive patients with AIS-LVO treated by thrombectomy. Baseline CTA was used to assess collateral status (Tan scale) and VO using the Cortical Vein Opacification Score (COVES). Favorable VO was defined as COVES ≥3. Primary outcome was excellent vessel reperfusion status (modified Thrombolysis in Cerebral Infarction 2c/3). Secondary outcome was good functional outcome defined as a score of 0 to 2 on the modified Rankin Scale after 90 days.

Results: Five hundred sixty-five patients met the inclusion criteria. Multivariable logistic regression analysis showed that favorable VO (odds ratio [OR] 2.10 [95% confidence interval (CI) 1.39-3.16]; p < 0.001) was associated with excellent vessel reperfusion during thrombectomy, regardless of good CTA collateral status (OR 0.87 [95% CI 0.58-1.34]; p = 0.48). A favorable VO profile (OR 8.9 [95%CI 5.3-14.9]; p < 0.001) and excellent vessel reperfusion status (OR 2.7 [95%CI 1.7-4.4]; p < 0.001) were independently associated with good functional outcome adjusted for age, sex, glucose, tissue plasminogen activator administration, good CTA collateral status, and presentation NIH Stroke Scale score.

Conclusion: A favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.

Classification of evidence: This study provides Class II evidence that a favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.

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