Absent Filling of Ipsilateral Superficial Middle Cerebral Vein Is Associated With Poor Outcome After Reperfusion Therapy.
Absent Filling of Ipsilateral Superficial Middle Cerebral Vein Is Associated With Poor Outcome After Reperfusion Therapy.
复制标题
同侧大脑浅静脉充盈不足与再灌注治疗后的不良结果相关
DOI：
10.1161/strokeaha.116.016174
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发表时间：
2017-04
期刊：
影响因子：
8.3
通讯作者：
Lou M
中科院分区：
文献类型：
--
作者：
Zhang S;Lai Y;Ding X;Parsons M;Zhang JH;Lou M
我们的目的是研究皮质静脉引流，包括大脑中浅静脉 (SMCV)、Trolard 静脉 (VOT) 和 Labbé 静脉 (VOL) 对再灌注治疗后神经功能的影响。纳入治疗前连续CT灌注（CTP）和静脉溶栓后24小时CTP或MR灌注的连续缺血性脑卒中患者。我们将“同侧皮质静脉缺乏充盈”（例如 SMCV-）定义为缺血半球四维 CT 血管造影上整个静脉期静脉没有造影剂充盈。在 228 名患者中，分别有 50 名 (21.9%)、27 名 (11.8%) 和 32 名 (14.0%) 患者观察到 SMCV-、VOT- 和 VOL-。仅 SMCV- 独立预测不良结果（3 个月改良Rankin 量表评分>2）（OR=2.710，p=0.040）。有和没有SMCV-的患者治疗后的再灌注率没有差异（p>0.05）。在实现严重再灌注（≥80%）的患者中，有和没有 SMCV- 的患者之间 24 小时梗死体积或不良预后率没有差异（p>0.05）。然而，与 SMCV 充盈患者相比，在没有严重再灌注的患者中，SMCV- 患者的 24 小时梗塞体积更大（p=0.011），不良结局发生率更高（p=0.012），死亡率更高（p=0.032）。 SMCV- 与 24 小时脑水肿显着相关 (p=0.037)，而脑水肿又与 3 个月预后不良相关 (p=0.002)。 SMCV 充盈不足导致溶栓后预后不良，尤其是未实现再灌注时。静脉充盈不良的主要有害影响似乎与脑水肿的发生有关。
Our aim was to study the effect of drainage of cortical veins, including the superficial middle cerebral vein (SMCV), vein of Trolard (VOT), and vein of Labbé (VOL) on neurological outcomes after reperfusion therapy. Consecutive ischemic stroke patients who underwent pretreatment CT perfusion (CTP) and 24-hour CTP or MR perfusion after intravenous thrombolysis were included. We defined “absent filling of ipsilateral cortical vein” (e.g. SMCV-) as no contrast filling of the vein across the whole venous phase on four-dimensional CT angiography in the ischemic hemisphere. Of 228 patients, SMCV-, VOT- and VOL- were observed in 50 (21.9%), 27 (11.8%), and 32 (14.0%) patients, respectively. Only SMCV- independently predicted poor outcome (3-month modified Rankin Scale score>2) (OR=2.710, p=0.040). No difference was found in reperfusion rate after treatment between patients with and without SMCV- (p>0.05). In patients achieving major reperfusion (≥80%), there was no difference in 24-hour infarct volume, or rate of poor outcome between patients with and without SMCV- (p>0.05). However, in those without major reperfusion, patients with SMCV- had larger 24-hour infarct volume (p=0.011), higher rate of poor outcome (p=0.012), and death (p=0.032), compared to those with SMCV filling. SMCV- was significantly associated with brain edema at 24 hours (p=0.037) which, in turn, was associated with poor 3-month outcome (p=0.002). Lack of SMCV filling contributed to poor outcome after thrombolysis, especially when reperfusion was not achieved. The main deleterious effect of poor venous filling appears related to the development of brain edema.