Background Venous outflow (VO) has emerged as a robust measure of collateral blood flow in acute ischemic stroke patients with a large vessel occlusion (AIS-LVO). VO is commonly measured by the cortical vein opacification score (COVES), which represents only cortical venous drainage of the middle cerebral artery territory. The addition of deep venous drainage to VO assessment may provide valuable information to further guide the treatment of these patients.
Methods We performed a multicenter retrospective cohort study of AIS-LVO patients treated by thrombectomy. We quantified opacification of the internal cerebral veins on a scale of 0 to 2, analogous to the scoring system of COVES. This metric was combined to existing COVES scores in this patient cohort to create the comprehensive venous outflow score (CVO) from 0 to 8 and stratify patients by favorable (CVO+) versus poor VO (CVO-). The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0-2, at 90-day follow-up. The secondary outcome was excellent reperfusion, defined as thrombolysis in cerebral infarction scores of 2c/3.
Results 678 patients met inclusion criteria, and 315 were stratified into the CVO+ category and 363 into the CVO- category after deep venous scoring was added. There were significantly higher rates of functional independence (mRS 0-2; 194/296 vs. 37/352, 66% vs. 11%, p < 0.001) and excellent reperfusion (TICI 2c/3; 166/313 vs. 142/358, 53% vs. 40%, p < 0.001) in CVO+ patients compared to in CVO- patients. There was a significant increase in association of mRS with CVO compared to with COVES (-0.74 vs. -0.67, p = 0.006).
Conclusions A new comprehensive VO score, inclusive of deep veins, was found to have a significantly greater association with functional independence at 90 days than COVES alone. A favorable CVO profile is strongly associated with functional independence and excellent post-thrombectomy reperfusion. Future studies should focus on patients with CVO status that is discrepant to eventual outcome.
Disclosures G. Adusumilli: None. T. Faizy: None. S. Christensen: 2; C; iSchemaView. 4; C; iSchemaView. M. Mlynash: None. Y. Loh: None. G. Albers: 2; C; iSchemaView, Genentech. 4; C; iSchemaView. M. Lansberg: None. J. Fiehler: 1; C; Acandis, Cerenovus, MicroVention, Medtronic, Stryker, Route 92. 6; C; Acandis, Cerenovus, MicroVention, Medtronic, Stryker, Phenox, Penumbra. J. Heit: 2; C; Medtronic, MicroVention. 6; C; iSchemaView.
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