Venous imaging-based biomarkers in acute ischaemic stroke

Munuera, Josep; Blasco, Gerard; Hernández‐Pérez, María; Daunis‐i‐Estadella, Pepus; Dávalos, Antoni; Liebeskind, David S; Wintermark, Max; Demchuk, Andrew M.; Menon, Bijoy K; Thomalla, Götz; Nael, Kambiz; Pedraza, Salvador; Puig, Josep

doi:10.1136/jnnp-2016-314814

Cited by 28 publications

(14 citation statements)

References 35 publications

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“…We found an occlusion or hypoplasia of the transverse sinus in 30% and of the internal jugular vein in 18% of patients. This is in line with earlier reports regarding human cerebral venous drainage ( 14 – 16 ).…”

Section: Discussionsupporting

confidence: 93%

Cerebral Venous Drainage in Patients With Space-Occupying Middle Cerebral Artery Infarction: Effects on Functional Outcome After Hemicraniectomy

et al. 2018

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Background: Cerebral venous drainage might influence brain edema characteristics and functional outcome of patients with severe ischemic stroke. The purpose of the study was to evaluate whether hypoplasia of transverse sinuses or the internal jugular veins is associated with poor functional outcome in patients with space-occupying middle cerebral artery (MCA) infarction who underwent decompressive surgery.Methods: We performed a retrospective analysis of patients with space-occupying MCA infarction treated with decompressive surgery at our university hospital. The transverse sinuses and the internal jugular veins were evaluated on baseline images and categorized as normal, hypoplastic or occluded. We defined composite variables for ipsilateral, contralateral or any abnormal cerebral venous drainage. We assessed the functional outcome at 12 months with the modified Rankin scale (mRS) score and defined poor functional outcome as mRS scores 5 and 6.Results: We analyzed 88 patients with available baseline imaging data [mean [SD] patient age 53 (±9) years; median[IQR] time to decompressive surgery 31(22-51) h]. At 12 months 44 patients (50%) had a poor outcome. In univariate analysis neither ipsilateral (OR 1.98;95%CI: 0.75–5.40), nor contralateral (OR 1.56;95%CI: 0.59–4.24) or any (OR 1.6; 95%CI: 0.68–3.79) hypoplasia or occlusion of venous drainage were significantly associated with poor functional outcome. In multivariate analyses, higher patient age (OR 1.07;95%CI 1.01–1.14) and baseline stroke severity (OR 3.42;95%CI 1.31–9.40) were independent predictors of poor functional outcome, but not ipsilateral hypoplasia or occlusion of venous drainage (OR 1.31;95%CI 0.47–3.67).Conclusions: The cerebral venous drainage pattern was not significantly associated with poor functional outcome in our cohort of patients with space-occupying MCA infarction who underwent decompressive surgery.

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Section: Discussionsupporting

confidence: 93%

Cerebral Venous Drainage in Patients With Space-Occupying Middle Cerebral Artery Infarction: Effects on Functional Outcome After Hemicraniectomy

et al. 2018

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“…The venous compartment is related to collateral blood flow and could be involved in the hemodynamics of RSSIs. 45 In this cohort, there were no differences in the GVD between patients with different perfusion patterns, but local flow abnormalities in veins supplying RSSIs may be present and should be assessed in the future by more detailed dynamic angiography studies.…”

Section: Discussionmentioning

confidence: 64%

Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Rudilosso

Laredo

Mancosu³

et al. 2018

J Cereb Blood Flow Metab

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Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts of the brain, but other perfusion patterns may be present in patients with these infarcts. Using CT perfusion, we studied 67 consecutive patients who had a small subcortical infarct at a follow-up MRI study to investigate the correlation between the perfusion pattern and the clinical and radiological course. On CT perfusion map analysis, 51 patients (76%) had focal hypoperfusion, 4 patients (6%) had hyperperfusion and the remaining 12 patients (18%) showed no abnormalities. On dynamic sequential imaging analysis obtained from the source perfusion images, 32 patients (48%) had a sustained hypoperfusion pattern, 11 patients (16%) had a reperfusion pattern, and 18 patients (27%) had a delayed compensation pattern. Systolic blood pressure was higher in patients with sustained hypoperfusion although the perfusion pattern was independent of the final volume of infarction. These results reinforce the notion that mechanisms other than hypoperfusion are at play in patients with small subcortical infarcts including the intervention of compensatory sources of blood flow. The ultimate clinical significance of these perfusion patterns remains to be determined in larger series of patients assessed longitudinally.

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“…Several additional radiologic studies supported that increased arterial and venous phase information would lead to more accurate collateral evaluations (Beyer et al, 2015a, 2015b). It is therefore assumed that the opacification of venous system provides additional information of both the extent of arterial and venous collaterals and the actual perfusion through the microcirculation, given the unneglectable and coherent role the venous system plays in the ischemic event (Munuera et al, 2017).…”

Section: The Importance Of Identifying Cerebral Venous System Changesmentioning

confidence: 99%

Cerebral venous collaterals: A new fort for fighting ischemic stroke?

Tong

Guo

et al. 2018

Progress in Neurobiology

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Stroke therapy has entered a new era highlighted by the use of endovascular therapy in addition to intravenous thrombolysis. However, the efficacy of current therapeutic regimens might be reduced by their associated adverse events. For example, over-reperfusion and futile recanalization may lead to large infarct, brain swelling, hemorrhagic complication and neurological deterioration. The traditional pathophysiological understanding on ischemic stroke can hardly address these occurrences. Accumulating evidence suggests that a functional cerebral venous drainage, the major blood reservoir and drainage system in brain, may be as critical as arterial infusion for stroke evolution and clinical sequelae. Further exploration of the multi-faceted function of cerebral venous system may add new implications for stroke outcome prediction and future therapeutic decision-making. In this review, we emphasize the anatomical and functional characteristics of the cerebral venous system and illustrate its necessity in facilitating the arterial infusion and maintaining the cerebral perfusion in the pathological stroke content. We then summarize the recent critical clinical studies that underscore the associations between cerebral venous collateral and outcome of ischemic stroke with advanced imaging techniques. A novel three-level venous system classification is proposed to demonstrate the distinct characteristics of venous collaterals in the setting of ischemic stroke. Finally, we discuss the current directions for assessment of cerebral venous collaterals and provide future challenges and opportunities for therapeutic strategies in the light of these new concepts.

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Venous imaging-based biomarkers in acute ischaemic stroke

Cited by 28 publications

References 35 publications

Cerebral Venous Drainage in Patients With Space-Occupying Middle Cerebral Artery Infarction: Effects on Functional Outcome After Hemicraniectomy

Cerebral Venous Drainage in Patients With Space-Occupying Middle Cerebral Artery Infarction: Effects on Functional Outcome After Hemicraniectomy

Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Cerebral venous collaterals: A new fort for fighting ischemic stroke?

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