Poor venous outflow is associated with hyperintense acute reperfusion marker on follow-up MRI in patients with acute ischemic stroke with a large vessel occlusion.

IF 4.5 1区医学 Q1 NEUROIMAGING Journal of NeuroInterventional Surgery Pub Date : 2024-10-11 DOI:10.1136/jnis-2024-022064

Aroosa Zamarud, Nicole Yuen, Anke Wouters, Michael Mlynash, Stephen M Hugdal, Pierre Seners, Jamie Kesten, Vivek Yedavalli, Tobias D Faizy, Gregory W Albers, Maarten G Lansberg, Jeremy J Heit

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Abstract

Background: Hyperintense acute reperfusion marker (HARM) refers to delayed enhancement in the subarachnoid or subpial space on post-contrast fluid attenuated inversion recovery (FLAIR) images. HARM is a measure of blood-brain barrier breakdown, which has been correlated with poor outcomes in patients with acute ischemic stroke with large vessel occlusion (AIS-LVO). We hypothesized that unfavorable venous outflow (VO) would be correlated with HARM after thrombectomy treatment of AIS-LVO.

Objective: To determine whether poor VO is associated with HARM on follow-up MRI after stroke in patients with AIS-LVO.

Methods: Patients with AIS-LVO from the prospective CRISP2 and DEFUSE2 studies with a baseline CT angiography (CTA) scan and a follow-up MRI with FLAIR sequence were screened for enrollment. VO was measured on the baseline CTA scan using the cortical venous opacification score (COVES). HARM was determined on FLAIR sequences at the follow-up MRI. The primary outcome was the occurrence of HARM between those with good VO (VO+; COVES 3-6) and bad VO (VO-; COVES 0-2).

Results: 121 patients were included; 60.3% (n=73) had VO+ and 39.7% (n=48) had VO-. Patients with VO- had higher presentation National Institutes of Health Stroke Scale scores (18 (IQR 12-20) vs 12 (IQR 8-16) in VO+; P<0.001). Middle cerebral artery M1 segment occlusions were more common in VO- patients (65% vs 43% VO+; P=0.028). VO- patients also had a larger pre-treatment ischemic core (23 (4-44) mL vs 12 (3-22) mL in VO+; P=0.049) and Tmax >6 s volumes (105 (72-142) mL vs 66 (35-95) mL in VO+; P<0.001). VO- patients were more likely to develop HARM after thrombectomy (31% vs 10% in VO+; P=0.003). On multivariable regression analysis, VO- (OR=3.6 (95% CI 1.2 to 10.6); P=0.02) and the presence of any ICH (OR=3.6 (95% CI 1.2 to 10.5); P=0.02) were independently associated with the occurrence of HARM.

Conclusions: In patients with AIS-LVO, VO- correlated with HARM on post-thrombectomy MRI.

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静脉流出不畅与大血管闭塞的急性缺血性脑卒中患者随访磁共振成像中急性再灌注标记物的高强化有关。

背景：高强化急性再灌注标志物（HARM）是指对比后液体衰减反转恢复（FLAIR）图像上蛛网膜下腔或皮下腔的延迟强化。HARM 是衡量血脑屏障破坏程度的指标，与急性缺血性中风伴大血管闭塞（AIS-LVO）患者的不良预后相关。我们假设，在血栓切除术治疗 AIS-LVO 后，不利的静脉外流（VO）将与 HARM 相关：目的：确定不良静脉外流是否与 AIS-LVO 患者卒中后随访 MRI 上的 HARM 相关：从前瞻性 CRISP2 和 DEFUSE2 研究中筛选出基线 CT 血管造影 (CTA) 扫描和 FLAIR 序列随访 MRI 的 AIS-LVO 患者。在基线 CTA 扫描中使用皮质静脉不透明评分（COVES）测量 VO。HARM 是在随访 MRI 的 FLAIR 序列上确定的。主要结果是VO良好（VO+；COVES 3-6）和VO不良（VO-；COVES 0-2）患者的HARM发生率：共纳入121名患者，其中60.3%（n=73）的患者VO+，39.7%（n=48）的患者VO-。VO-患者的美国国立卫生研究院卒中量表评分较高（VO+为18（IQR 12-20）分，VO-为12（IQR 8-16）分；P6 s容量为105（72-142）毫升，VO+为66（35-95）毫升；PC结论：在 AIS-LVO 患者中，VO- 与血栓切除术后磁共振成像的 HARM 相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.