Purpose The quality of cerebral microperfusion (CM) is strongly related to vessel occlusion location and the robustness of arterial intracranial collaterals (IC) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). The venous microcirculation profile (VMP) may more accurately reflect tissue perfusion compared to arterial IC, but it is unclear to what extent the venous CM profile is affected by arterial clot localization. We determined, if the arterial vessel occlusion localizations predict VMP profile in AIS-LVO patients.

Materials and Methods We performed a multicenter retrospective cohort study of consecutive patients who underwent thrombectomy for AIS-LVO treatment. Patient details were obtained from prospectively maintained stroke databases and the electronic medical record. Baseline CT angiography was used to localize vessel occlusion, which was dichotomized into proximal (internal carotid artery and proximal M1) and distal (distal M1 and M2) occlusions. The primary outcome measure was VMP, which was determined on baseline CTA by the cortical vein opacification score (COVES). COVES for the vein of Labbé, sphenoparietal sinus, and superficial middle cerebral vein were scored as: 0, not visible; 1, moderate opacification; and 2, full opacification.

Results 374 patients met inclusion criteria. 196 patients (52%) had a proximal occlusion and 178 patients (48%) had a distal occlusion. Median COVES was 1 (range 0–5) for proximal occlusion and 3 (range 0–6) for distal occlusion patients. Mann-Whitney-U tests indicated a significant difference between proximal and distal occlusions (p<0.001). Ordinal logistic regression showed that patients with more distal vs proximal occlusions had increased odds of having higher COVES (OR=12.62, [95% CI 8.02- 20.22]; p<0.001), independent of age or presentation NIHSS.

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Abstract O-034 Figure 1 Displays examples of cortical vein opacification scores (COVES) in 2 different patients with proximal (top row, patient 1, dotted white arrow) and distal (bottom row, patient 2) large vessel occlusion. Red arrows indicate poor venous opacification, whereas green arrows represent higher COVES represented by strong vessel opacification. No visible opacification was detected in the right vein of Labe, whereas strong opacification over the full length of the left vein was detected (COVES 0 right, COVES 2 left). In patient 2, strong opacification of the veins of Labe was found on both hemispheres (COVES 2 on both sides)

Conclusion The distinct arterial clot localization in AIS-LVO patients affects the cortical venous microperfusion profile. Venous microperfusion was found to be impaired in patients with proximal versus distal vessel occlusions.

Disclosures T. Faizy: None. R. Kabiri: None. M. Leipzig: None. G. Broocks: None. S. Christensen: None. F. Flottmann: None. M. Lansberg: None. G. Albers: None. J. Fiehler: None. M. Wintermark: None. J. Heit: None.