PT  - JOURNAL ARTICLE
AU  - Noel van Horn
AU  - Jeremy J Heit
AU  - Reza Kabiri
AU  - Marius M Mader
AU  - Soren Christensen
AU  - Michael Mlynash
AU  - Gabriel Broocks
AU  - Lukas Meyer
AU  - Jawed Nawabi
AU  - Maarten G Lansberg
AU  - Gregory W Albers
AU  - Max Wintermark
AU  - Jens Fiehler
AU  - Tobias D Faizy
TI  - Cerebral venous outflow profiles are associated with the first pass effect in endovascular thrombectomy
AID  - 10.1136/neurintsurg-2021-018078
DP  - 2022 Nov 01
TA  - Journal of NeuroInterventional Surgery
PG  - 1056--1061
VI  - 14
IP  - 11
4099  - http://jnis.bmj.com/content/14/11/1056.short
4100  - http://jnis.bmj.com/content/14/11/1056.full
SO  - J NeuroIntervent Surg2022 Nov 01; 14
AB  - Background Recent studies found that favorable venous outflow (VO) profiles are associated with higher reperfusion rates after mechanical thrombectomy (MT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Fewer retrieval attempts and first-pass revascularization during MT lead to better functional outcomes.Objective To examine the hypothesis that favorable VO profiles assessed on baseline CT angiography (CTA) images correlate with successful vessel reperfusion after the first retrieval attempt and fewer retrieval attempts.Methods A multicenter retrospective cohort study of patients with AIS-LVO treated by MT. Baseline CTA was used to determine the cortical vein opacification score (COVES). Favorable VO was defined as COVES ≥3. Primary outcomes were successful with excellent vessel reperfusion status, defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3 and 2c/3 after first retrieval attempt.Results 617 patients were included in this study, of whom 205 (33.2%) had first pass reperfusion. In univariate analysis, ordinal COVES (p=0.011) values were significantly higher in patients with first pass than in those with non-first pass reperfusion, while the number of patients exhibiting favorable pial arterial collaterals using the Maas scale on CTA did not differ (p=0.243). In multivariable logistic regression analysis, higher COVES were independently associated with TICI 2b/3 (OR=1.25, 95% CI 1.1 to 1.42; p=0.001) and TICI 2c/3 (OR=1.2, 95% CI 1.04 to 1.36; p=0.011) reperfusion after one retrieval attempt, controlling for penumbra volume and time from symptom onset to vessel reperfusion.Conclusions Favorable VO, classified as higher COVES, is independently associated with successful and excellent first pass reperfusion in patients with AIS-LVO treated by endovascular thrombectomy.Data are available upon reasonable request.