Universität zu Köln

van Horn, Noel ORCID: 0000-0001-5764-1982, Heit, Jeremy J., Kabiri, Reza, Broocks, Gabriel ORCID: 0000-0002-7575-9850, Christensen, Soren, Mlynash, Michael, Meyer, Lukas ORCID: 0000-0002-3776-638X, Schoenfeld, Michael H., Lansberg, Maarten G., Albers, Gregory W., Fiehler, Jens, Wintermark, Max and Faizy, Tobias D. (2022). Venous outflow profiles are associated with early edema progression in ischemic stroke. Int. J. Stroke, 17 (10). S. 1078 - 1085. LONDON: SAGE PUBLICATIONS LTD. ISSN 1747-4949

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Abstract

Background: In patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO), development of extensive early ischemic brain edema is associated with poor functional outcomes, despite timely treatment. Robust cortical venous outflow (VO) profiles correlate with favorable tissue perfusion. We hypothesized that favorable VO profiles (VO+) correlate with a reduced early edema progression rate (EPR) and good functional outcomes. Methods: Multicenter, retrospective analysis to investigate AIS-LVO patients treated by mechanical thrombectomy between May 2013 and December 2020. Baseline computed tomography angiography (CTA) was used to determine VO using the cortical vein opacification score (COVES); VO+ was defined as COVES > 3 and unfavorable as COVES <= 2. EPR was determined as the ratio of net water uptake (NWU) on baseline non-contrast CT and time from symptom onset to admission imaging. Multivariable regression analysis was performed to assess primary (EPR) and secondary outcome (good functional outcomes defined as 0-2 points on the modified Rankin scale). Results: A total of 728 patients were included. Primary outcome analysis showed VO+ (beta: -0.03, SE: 0.009, p = 0.002), lower presentation National Institutes of Health Stroke Scale (NIHSS; beta: 0.002, SE: 0.001, p = 0.002), and decreased time from onset to admission imaging (beta: -0.00002, SE: 0.00004, p < 0.001) were independently associated with reduced EPR. VO+ also predicted good functional outcomes (odds ratio (OR): 5.07, 95% CI: 2.839-9.039, p < 0.001), while controlling for presentation NIHSS, time from onset to imaging, general vessel reperfusion, baseline Alberta Stroke Program Early CT Score, infarct core volume, EPR, and favorable arterial collaterals. Conclusions: Favorable VO profiles were associated with slower infarct edema progression and good long-term functional outcomes as well as better neurological status and ischemic brain alterations at admission.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code van Horn, Noel UNSPECIFIED orcid.org/0000-0001-5764-1982 UNSPECIFIED Heit, Jeremy J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabiri, Reza UNSPECIFIED UNSPECIFIED UNSPECIFIED Broocks, Gabriel UNSPECIFIED orcid.org/0000-0002-7575-9850 UNSPECIFIED Christensen, Soren UNSPECIFIED UNSPECIFIED UNSPECIFIED Mlynash, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Lukas UNSPECIFIED orcid.org/0000-0002-3776-638X UNSPECIFIED Schoenfeld, Michael H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lansberg, Maarten G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Albers, Gregory W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fiehler, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Wintermark, Max UNSPECIFIED UNSPECIFIED UNSPECIFIED Faizy, Tobias D. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-677055
DOI:	10.1177/17474930211065635
Journal or Publication Title:	Int. J. Stroke
Volume:	17
Number:	10
Page Range:	S. 1078 - 1085
Date:	2022
Publisher:	SAGE PUBLICATIONS LTD
Place of Publication:	LONDON
ISSN:	1747-4949
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LESION WATER-UPTAKE; INTRAARTERIAL THERAPY; CT-ANGIOGRAPHY; BENEFIT Multiple languages Clinical Neurology; Peripheral Vascular Disease Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/67705