Venous Outflow Profiles Are Linked to Clinical Outcomes in Ischemic Stroke Patients with Extensive Baseline Infarct

Winkelmeier, Laurens; Broocks, Gabriel; Kniep, Helge; Geest, Vincent; Reinwald, Jonathan; Meyer, Lukas; Horn, Noel van; Guenego, Adrien; Zeleňák, Kamil; Albers, Gregory W.; Lansberg, Maarten G; Sporns, Peter; Wintermark, Max; Fiehler, Jens; Heit, Jeremy J; Faizy, Tobias D.

doi:10.5853/jos.2022.01046

Cited by 19 publications

(19 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this regard, VO profiles were found to be strongly correlated with tissue-level collaterals [15]. This hypothesis is supported by the results of other studies on various stroke patient subgroups, which found that VO profiles have yielded a strong association with clinical outcomes [16,[29][30][31]. However, more research is needed to determine the specific pathophysiological causes of the uncoupling of arterial and venous cerebral perfusion.…”

Section: Discussionsupporting

confidence: 59%

“…In total, COVES ranges from 0 to 6 points. Unfavorable VO was defined as COVES ≤ 2 according to previous studies [15,16]. Ratings were performed by two neuroradiologists (T.D.F.…”

Section: Imaging Analysismentioning

confidence: 99%

“…Recent studies found an association between favorable VO profiles and lower edema formation, higher rates of first pass recanalization during MT, and better functional outcomes [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients

Heitkamp

Winkelmeier

Heit

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

Background and purpose Mechanical thrombectomy (MT) has proven to be the standard of care for patients with acute ischemic stroke due to large vessel occlusion (AIS‐LVO). However, high revascularization rates do not necessarily result in favorable functional outcomes. We aimed to investigate imaging biomarkers associated with futile recanalization, defined as unfavorable functional outcome despite successful recanalization in AIS‐LVO patients. Methods A retrospective multicenter cohort study was made of AIS‐LVO patients treated by MT. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction score of 2b–3. A modified Rankin Scale score of 3–6 at 90 days was defined as unfavorable functional outcome. Cortical Vein Opacification Score (COVES) was used to assess venous outflow (VO), and the Tan scale was utilized to determine pial arterial collaterals on admission computed tomography angiography (CTA). Unfavorable VO was defined as COVES ≤ 2. Multivariable regression analysis was performed to investigate vascular imaging factors associated with futile recanalization. Results Among 539 patients in whom successful recanalization was achieved, unfavorable functional outcome was observed in 59% of patients. Fifty‐eight percent of patients had unfavorable VO, and 31% exhibited poor pial arterial collaterals. In multivariable regression, unfavorable VO was a strong predictor (adjusted odds ratio = 4.79, 95% confidence interval = 2.48–9.23) of unfavorable functional outcome despite successful recanalization. Conclusions We observe that unfavorable VO on admission CTA is a strong predictor of unfavorable functional outcomes despite successful vessel recanalization in AIS‐LVO patients. Assessment of VO profiles could help as a pretreatment imaging biomarker to determine patients at risk for futile recanalization.

show abstract

Section: Discussionsupporting

confidence: 59%

“…In total, COVES ranges from 0 to 6 points. Unfavorable VO was defined as COVES ≤ 2 according to previous studies [15,16]. Ratings were performed by two neuroradiologists (T.D.F.…”

Section: Imaging Analysismentioning

confidence: 99%

See 1 more Smart Citation

Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients

Heitkamp

Winkelmeier

Heit

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

“…The baseline National Institutes of Health Stroke Scale (NIHSS) score was significantly higher in patients with perfusion delay than in those without perfusion delay in the low cerebellum [17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) vs. 8 (6-15), P = 0.002; Table 1]. The mRS score at 3 months was significantly higher [5.0 (4.0-5.0) vs. 2.0 (1.0-4.0), P = 0.001], and the proportion of good functional outcomes was significantly lower in those with perfusion delay [5 (20.8%) vs. 13 (72.2%), P = 0.003; Supplementary Figure S2].…”

Section: Resultsmentioning

confidence: 99%

“…However, not only the inflow of arterial blood to the brain but also the venous outflow can affect the outcome of stroke. Previous studies found that venous outflow associated with perfusion delay could be a predictor of the outcome in patients with MT (8,(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Delayed low cerebellar perfusion status is associated with poor outcomes in top-of-basilar occlusion treated with thrombectomy

et al. 2023

View full text Add to dashboard Cite

Background and purposeTop-of-basilar artery occlusion (TOB) is one of the most devastating strokes despite successful mechanical thrombectomy (MT). We aimed to investigate the impact of initial low cerebellum perfusion delay on the outcomes of TOB treated with MT.MethodsWe included patients who underwent MT for TOB. Clinical and peri-procedural variables were obtained. Perfusion delay in the low cerebellum was defined as (1) time-to-maximum (Tmax) >10 s lesions or (2) relative time-to-peak (rTTP) map >9.5 s with a diameter of ≥6 mm in the low cerebellum. The good functional outcome was defined as the achievement of a modified Rankin Scale score of 0–3 at 3 months after stroke.ResultsAmong the 42 included patients, 24 (57.1%) patients showed perfusion delay in the low cerebellum. The admission National Institutes of Health Stroke Scale (NIHSS) score was significantly higher in those with perfusion delay [17 (12–24) vs. 8 (6–15), P = 0.002]. Accordingly, the proportion of good functional outcomes was lower in those with perfusion delay than in those without [5 (20.8%) vs. 13 (72.2%), P = 0.003]. From the multivariable analysis, the admission NIHSS score [odds ratio (OR) = 0.86, 95% confidence intervals (CIs) = 0.75–0.98, P = 0.021] and low cerebellum perfusion delay (OR = 0.18, 95% Cis = 0.04–0.86, P = 0.031) were independently associated with the 3-month functional outcomes.ConclusionWe found that initial perfusion delay proximal to TOB in the low cerebellum might be a predictor for poor functional outcomes in TOB treated with MT.

show abstract

Age and Functional Outcomes in Patients With Large Ischemic Stroke Receiving Endovascular Thrombectomy

Winkelmeier,

Kniep,

Faizy

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceRandomized clinical trials have demonstrated the efficacy and safety of endovascular thrombectomy for acute ischemic stroke with large infarct. Patients older than 80 years with large infarct are commonly encountered in clinical practice but underrepresented in randomized clinical trials.ObjectiveTo provide an age-based analysis of functional outcomes in endovascular thrombectomy for acute ischemic strokes with large infarct.Design, Setting, and ParticipantsThis retrospective multicenter cohort study included patients from the German Stroke Registry who received endovascular thrombectomy for acute ischemic stroke with large infarct at 1 of 25 German stroke centers between May 2015 and December 2021. Patients with acute ischemic stroke due to anterior circulation large vessel occlusion and large infarct were included. Large infarct was defined as an Alberta Stroke Program Early Computed Tomography Score of 0 to 5. Patients were subdivided by age to evaluate its association with functional outcomes.ExposureAge.Main Outcomes and MeasuresPrimary outcomes were independent ambulation (90-day modified Rankin Scale score of 0-3) and mortality (90-day modified Rankin Scale score of 6).ResultsA total of 408 patients with large infarct were included (217 women [53.2%]; median [IQR] age, 75 [64-83] years). The rate of independent ambulation decreased from 56.4% in patients aged 60 years and younger (44 of 78 patients) to 15.1% in patients older than 80 years (19 of 126 patients) (P &lt; .001), while mortality increased from 15.4% (12 patients) to 64.3% (81 patients) (P &lt; .001). Being older than 80 years was associated with lower rates of independent ambulation (adjusted odds ratio [aOR], 0.44; 95% CI, 0.23-0.82; P = .01) and higher mortality (aOR, 2.75; 95% CI, 1.61-4.72; P &lt; .001). A final modified Thrombolysis in Cerebral Infarction grade of 2b or 3 was associated with higher rates of independent ambulation (aOR, 4.95; 95% CI, 2.14-11.43; P &lt; .001), independent of age and without significant interaction (aOR, 0.69; 95% CI, 0.35-1.34; P = .27).Conclusions and RelevanceIn this cohort study of patients with acute ischemic stroke and large infarct, age was associated with functional outcomes. Patients older than 80 years had poor prognosis with high mortality but with sizeable differences depending on additional baseline and treatment characteristics. While it does not seem justified to apply a fixed upper age limit for endovascular thrombectomy, these results could assist clinicians in making informed treatment decisions in older patients with large ischemic stroke.

show abstract

Venous Outflow Profiles Are Linked to Clinical Outcomes in Ischemic Stroke Patients with Extensive Baseline Infarct

Cited by 19 publications

References 38 publications

Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients

Unfavorable cerebral venous outflow is associated with futile recanalization in acute ischemic stroke patients

Delayed low cerebellar perfusion status is associated with poor outcomes in top-of-basilar occlusion treated with thrombectomy

Age and Functional Outcomes in Patients With Large Ischemic Stroke Receiving Endovascular Thrombectomy

Contact Info

Product

Resources

About