Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy
Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy
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DOI：
10.1212/wnl.0000000000012106
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发表时间：
2021-06-15
期刊：
影响因子：
9.9
通讯作者：
Heit, Jeremy J.
中科院分区：
文献类型：
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作者：
Faizy, Tobias Djamsched;Kabiri, Reza;Heit, Jeremy J.
目的探讨大血管闭塞性急性缺血性脑卒中（AIS LVO）血栓切除术后稳定的侧支循环与再灌注的关系。良好的静脉流出（VO）反映了AIS-LVO患者良好的组织灌注和侧支循环状态。本研究的目的是确定治疗前CT血管造影（CTA）图像评估的有利VO特征是否与AIS-LVO患者血栓切除术后的成功血管再灌注相关。方法这是一项多中心回顾性队列研究，对接受血栓切除术治疗的AIS-LVO患者进行连续研究。基线CTA用于评估侧支循环状态（Tan量表）和采用皮质静脉混浊评分（COVES）的VO。有利VO定义为COVES >= 3。主要结局为血管再灌注状态良好（改良脑梗死溶栓2c/3）。次要结局是良好的功能结局，定义为90天后改良兰金量表评分为0 - 2分。结果565例患者符合纳入标准。多变量逻辑回归分析显示，有利的VO（比值比[OR] 2.10 [95%置信区间（CI）1.39-3.16]; p < 0.001）与血栓切除术期间良好的血管再灌注相关，而与良好的CTA侧支循环状态无关（OR 0.87 [95% CI 0.58-1.34]; p = 0.48）。良好的VO特征（OR 8.9 [95%CI 5.3-14.9]; p < 0.001）和良好的血管再灌注状态（OR 2.7 [95%CI 1.7-4.4]; p < 0.001）与良好的功能结局独立相关，这些功能结局经年龄、性别、血糖、组织纤溶酶原激活剂给药、良好的CTA侧支循环状态和NIH卒中量表评分校正。结论：在血管内血栓切除术治疗的AIS-LVO患者中，良好的VO特征与再灌注成功和良好的功能结局相关。证据分类本研究提供了II类证据，证明在接受血管内血栓切除术治疗的AIS-LVO患者中，有利的VO特征与再灌注成功和良好的功能结局相关。
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.