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  • Early venous filling after mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in anterior circulation

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Ischemic stroke
Original research
Early venous filling after mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in anterior circulation
  1. Yi Li1,2,
  2. Wenbo Cao1,3,
  3. Xin Xu1,3,
  4. Tianhua Li1,3,
  5. Yanfei Chen1,3,
  6. Yabing Wang1,3,
  7. Jian Chen1,3,
  8. Peng Gao1,3,
  9. Bin Yang1,3,
  10. Adam A Dmytriw4,5,
  11. Robert W Regenhardt5,
  12. Fei Chen6,
  13. Qingfeng Ma6,
  14. Jie Lu7,8,
  15. Yuqi Liu9,
  16. Chunliang Wang9,
  17. Xuesong Bai1,3,
  18. Liqun Jiao1,3
  1. 1 Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
  2. 2 Department of Neurology, Guangzhou Red Cross Hospital, Guangzhou, China
  3. 3 Department of Neurosurgery, China International Neuroscience Institute, Beijing, China
  4. 4 Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
  5. 5 Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  6. 6 Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
  7. 7 Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
  8. 8 Department of Radiology and Nuclear Medicine, Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
  9. 9 Department of Neurological Sciences, Escope Innovation Academy, Beijing, China
  1. Correspondence to Dr Liqun Jiao, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; liqunjiao{at}sina.cn; Dr Xuesong Bai, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; bxsben{at}163.com

Abstract

Background The significance of early venous filling (EVF) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is not fully understood. In this study, we aimed to investigate the impact of EVF after MT.

Methods From January 2019 to May 2022, AIS patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score (mTICI) ≥2b) after MT were retrospectively reviewed. EVF was evaluated on final digital subtraction angiography runs after successful recanalization and was categorized into phase subgroups (arterial phase and capillary phase) and pathway subgroups (cortical veins subgroup and thalamostriate veins subgroup), respectively. The impact of EVF subgroups on functional outcomes after successful recanalization were both investigated.

Results A total of 349 patients achieving successful recanalization after MT were included, including 45 patients in the EVF group and 304 patients in the non-EVF group. Multivariable logistic regression analysis showed the EVF group had a higher rate of intracranial hemorrhage (ICH; 66.7% vs 22%, adjusted odds ratio (aOR) 6.805, 95% CI 3.389 to 13.662, P<0.001), symptomatic ICH (sICH; 28.9% vs 4.9%, aOR 6.011, 95% CI 2.493 to 14.494, P<0.001) and malignant cerebral edema (MCE; 20% vs 6.9%, aOR 2.682, 95% CI 1.086 to 6.624, P=0.032) than the non-EVF group. Furthermore, the cortical veins subgroup of EVF had a higher rate of mortality than the thalamostriate veins subgroup (37.5% vs 10.3%, P=0.029).

Conclusions EVF is independently associated with ICH, sICH and MCE after successful recanalization of MT, but not with favorable outcome and mortality.

  • Atherosclerosis
  • Embolic
  • Stroke
  • Thrombectomy
  • Angiography

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020336

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • YL and WC are joint first authors.

    • Twitter @AdamDmytriw

    • YL and WC contributed equally.

    • XB and LJ contributed equally.

    • Contributors YL, WC, XX, TL, XB, YL, CW and LJ participated in the designation and conceptualization of this study. WC, XB and YL conducted data curation and statistical analysis. YC, YW, JC, PG, BY, FC and QM provided clinical data. JL provided imaging data. YL, WC, XX, TL, YC, YW, JC, PG, BY, FC and QM drafted and collated the manuscript. YL, WC, AAD, RWR, JL, YL, CW, XB and LJ edited and revised the manuscript. All the authors read and finally approved the published manuscript, and are responsible for ensuring the accuracy and completeness of the work. Liqun Jiao was specified as the guarantor of the manuscript and responsed for the overall content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.