The impacts of venous outflow profiles on outcomes among large vessel occlusion patients receiving endovascular treatment in the late window

Chen Gong; Liping Huang; Jiacheng Huang; Liyuan Chen; Weilin Kong; Yangmei Chen; Fengli Li; Chang Liu

doi:10.1007/s00330-024-10742-3

The impacts of venous outflow profiles on outcomes among large vessel occlusion patients receiving endovascular treatment in the late window

Eur Radiol. 2024 May 9. doi: 10.1007/s00330-024-10742-3. Online ahead of print.

Authors

Chen Gong^#¹, Liping Huang^#¹, Jiacheng Huang^#¹, Liyuan Chen^#¹, Weilin Kong², Yangmei Chen³, Fengli Li⁴, Chang Liu⁵

Affiliations

¹ Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
² Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400016, China.
³ Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. chenym1997@cqmu.edu.cn.
⁴ Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400016, China. lifengli01@yeah.net.
⁵ Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. liuchanghy@hospital.cqmu.edu.cn.

^# Contributed equally.

PMID: 38724767
DOI: 10.1007/s00330-024-10742-3

Abstract

Objectives: To investigate the association between venous outflow (VO) profiles and outcomes among acute ischemic stroke caused by anterior circulation large vessel occlusion (AIS-LVO) patients who had undergone endovascular treatment (EVT) in the late window of 6-24 h from stroke onset.

Methods: This was a post-hoc analysis of our preceding RESCUE-BT trial, with findings validated in an external cohort. Baseline computed tomographic angiography (CTA) was performed to assess VO using the Cortical Vein Opacification Score (COVES). The primary clinical outcome was functional independence at 90 days (modified Rankin Scale score of 0-2). The adjusted odd ratio (aOR) and confidence interval (CI) were obtained from multivariable logistic regressions.

Results: A total of 440 patients were included in the present study. After identifying the cutoff of COVES by marginal effects approach, enrolled patients were divided into the favorable VO group (COVES 4-6) and the poor VO (COVES 0-3) group. Multivariable logistic regression analysis showed that favorable VO (aOR 2.25; 95% CI 1.31-3.86; p = 0.003) was associated with functional independence. Similar results were detected in the external validation cohort. Among those with poor arterial collateralization, favorable VO was still an independent predictor of functional independence (aOR 2.09; 95% CI 1.06-4.10; p = 0.032).

Conclusion: The robust VO profile indicated by COVES 4-6 could promote the frequency of functional independence among AIS-LVO patients receiving EVT in the late window, and the prognostic value of VO was independent of the arterial collateral status.

Clinical relevance statement: The robust venous outflow profile was a valid predictor for functional independence among AIS-LVO patients receiving EVT in the late window (6-24 h) and the predictive role of venous outflow did not rely on the status of arterial collateral circulation.

Keywords: Cerebral veins; Computed tomography angiography; Ischemic stroke; Prognosis; Thrombectomy.

Abstract

Grants and funding