RT Journal Article
SR Electronic
T1 Internal cerebral vein asymmetry is an independent predictor of poor functional outcome in endovascular thrombectomy
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2021-017684
DO 10.1136/neurintsurg-2021-017684
A1 May Zin Myint
A1 Leonard LL Yeo
A1 Benjamin Y Q Tan
A1 Ei Zune The
A1 Mei Chin Lim
A1 Ching-Hui Sia
A1 Hock-Luen Teoh
A1 Vijay Kumar Sharma
A1 Bernard Chan
A1 Aftab Ahmad
A1 Prakash Paliwal
A1 Anil Gopinathan
A1 Cunli Yang
A1 Andrew Makmur
A1 Tommy Andersson
A1 Fabian Arnberg
A1 Staffan Holmin
YR 2021
UL http://jnis.bmj.com/content/early/2021/08/04/neurintsurg-2021-017684.abstract
AB 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.No data are available. All the data of participants are de-identified and collected from the hospital central registry.