Background Endovascular thrombectomy (EVT) in large vessel occlusion (LVO) in anterior circulation acute ischaemic stroke (AIS) results in good functional outcomes in only approximately 60% of the patients. Internal cerebral veins (ICVs) are easily visible, with a consistent midline location, and are linked to stroke outcomes. We hypothesize that ICV asymmetry on multiphasic CT angiogram (mCTA) can be an adjunctive predictor for poor functional outcomes.
Methods We studied consecutive AIS patients from 2017 to 2019 with anterior circulation LVO treated with EVT regardless of intravenous thrombolysis. Asymmetrical ICV was defined as the presence of hypodensity (less opacification) on the ipsilateral occlusion side as compared with the contralateral side. The primary outcome was modified Rankin Score (mRS) score at 3 months. Secondary outcomes were good recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3), symptomatic hemorrhage, and mortality.
Results A total of 185 patients were included with a median age of 70 years (IQR 59–77); 87 patients (47%) were female. 82 patients (44.3%) achieved good functional outcomes (mRS 0–2) at 3 months. On multivariate analysis, National Institutes of Health Stroke Scale (NIHSS) (OR 1.076, 95% CI 1.015 to 1.140; p<0.013), poor collateral score (OR 0.285, 95% CI 0.162 to 0.501; p<0.001), asymmetrical ICV on the peak venous phase (OR 2.47, 95% CI 1.115 to 5.471; p<0.026), and late venous phase of the mCTA (OR 2.642, 95% CI 1.161 to 6.016; p<0.021) were independent risks factors of poor outcomes.
Conclusion ICV asymmetry is a novel radiological sign which is independently associated with poor functional outcomes in EVT, even after correction for collateral circulation. Further studies are needed to validate this finding.
- CT angiography
Data availability statement
No data are available. All the data of participants are de-identified and collected from the hospital central registry.
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MZM and LLY are joint first authors.
MZM and LLY contributed equally.
Contributors MZM was involved in the conception of the article, data acquisition, data analysis, data interpretation, drafting of the article, the final approval, revising critically for important intellectual content and is agreeable to be accountable for all aspects of the work. LLLY was involved in the conception of the article, data acquisition, data analysis, data interpretation, drafting of the article and the final approval. BYQT was involved in data acquisition, data analysis and drafting of the article. MCL was involved in data acquisition, drafting of the article and the final approval. EZT, C-HS, H-LT, VKS, BC, AA, PP, AG, CY, AM, TA, FA and SH were involved in the drafting of the article and the final approval.
Funding This research was supported by the National Medical Research Council (NMRC), Singapore (Grant number: NMRC/FLWSHP/043/2017).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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