Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2024-11-11 DOI:10.1002/acn3.52243

Janet Mei, Hamza Adel Salim, Dhairya A. Lakhani, Licia Luna, Aneri Balar, Mona Shahriari, Nathan Z. Hyson, Francis Deng, Adam A. Dmytriw, Adrien Guenego, Vaibhav Vagal, Victor C. Urrutia, Elisabeth B. Marsh, Hanzhang Lu, Risheng Xu, Rich Leigh, Dylan Wolman, Gaurang Shah, Benjamin Pulli, Kambiz Nael, Gregory W. Albers, Max Wintermark, Jeremy J. Heit, Tobias D. Faizy, Argye E. Hillis, Raf Llinas, Vivek Yedavalli

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Abstract

Objective

Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with unfavorable 90-day functional outcomes despite successful reperfusion. This study investigates the association between PVT and percent change on the National Institutes of Health Stroke Scale (NIHSS) among AIS-LVO patients who have undergone successful reperfusion.

Methods

We performed a retrospective analysis of prospectively collected data from consecutive adult AIS-LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s in the superior sagittal sinus, torcula, or both. The primary outcome was continuous NIHSS percent change and dichotomous NIHSS percent change ≥70%. Regression analyses were performed to assess the effect of PVT on NIHSS percent change.

Results

In 119 patients of median (IQR) age 71 (63–81) years, the admission and discharge NIHSS scores were significantly higher in PVT+ patients compared to PVT− patients (17 [14–23.5] vs. 13 [9.5–19], p = 0.011, and 7.5 [4–12] vs. 3 [1–7], p < 0.001, respectively). After adjusting for age, sex, hypertension, diabetes, atrial fibrillation, administration of intravenous thrombolysis (IVT), Alberta Stroke Program Early CT Scores (ASPECTS), mTICI 2c and/or 3, Tmax >6 s volume, and hemorrhagic transformation, PVT+ was significantly associated with lower NIHSS percent change (B = −0.163, 95%CI −0.326 to −0.001, p = 0.049) and was less likely to achieve higher than 70% NIHSS improvement (OR = 0.331, 95% CI 0.127–0.863, p = 0.024).

Interpretation

PVT+ was significantly associated with reduced neurological improvement despite successful reperfusion in AIS-LVO patients, highlighting the critical role of VO impairment in short-term functional outcomes. These findings further validate PVT as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS-LVO.

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在成功再灌注的大血管脑卒中患者中，静脉过境时间延长与神经功能恢复较差有关。

目的大血管闭塞（AIS-LVO）导致的急性缺血性卒中患者静脉流出量（VO）受损预示着不利的预后。静脉转运时间延长（PVT）是 CT 灌注（CTP）时间到最大值（Tmax）图上直观的 VO 定性标记，尽管再灌注成功，但静脉转运时间延长与 90 天功能预后不良有关。本研究调查了成功接受再灌注的 AIS-LVO 患者的 PVT 与美国国立卫生研究院卒中量表（NIHSS）百分比变化之间的关系：我们对前瞻性收集的成功再灌注（改良脑梗塞溶栓疗法 2b/2c/3）的连续成人 AIS-LVO 患者的数据进行了回顾性分析。PVT+定义为上矢状窦、蝶窦或两者的Tmax≥10 s。主要结果为连续 NIHSS 百分比变化和二分 NIHSS 百分比变化≥70%。进行回归分析以评估 PVT 对 NIHSS 百分比变化的影响：在中位（IQR）年龄为 71（63-81）岁的 119 例患者中，PVT+ 患者的入院和出院 NIHSS 评分均显著高于 PVT- 患者（17 [14-23.5] vs. 13 [9.5-19]，p = 0.011；7.5 [4-12] vs. 3 [1-7]，p = 0.011）。PVT+ 与较低的 NIHSS 百分比变化显著相关（B = -0.163，95%CI -0.326--0.001，p = 0.049），且较少可能实现高于 70% 的 NIHSS 改善（OR = 0.331，95% CI 0.127-0.863，p = 0.024）：PVT+与AIS-LVO患者尽管成功再灌注但神经功能改善程度降低有明显相关性，突出了VO损伤在短期功能预后中的关键作用。这些研究结果进一步验证了 PVT 是一种有价值的辅助成像生物标记物，可通过 CTP 评估 AIS-LVO 患者的 VO 状况。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.