Deep Venous Outflow As a Surrogate for Collaterals in Late-window Patients with Successful Revascularization from the DEFUSE 3 Cohort

Overview

Journal Interv Neuroradiol

Publisher Sage Publications

Specialty Neurology

Date 2024 Aug 28

PMID 39194997

Authors

Gautam Adusumilli

Tobias D Faizy

Soren Christensen

Michael Mlynash

Yince Loh

Gregory W Albers

Maarten G Lansberg

Jens Fiehler

Jeremy J Heit

Affiliations

Soon will be listed here.

Abstract

Background: Deep venous outflow (VO) may be an important surrogate marker of collateral blood flow in acute ischemic stroke patients with a large vessel occlusion (AIS-LVO). Researchers have yet to determine the relationship between deep VO status in late-window patients and imaging measures of collaterals, which are key in preserving tissue.

Materials And Methods: We performed a multicenter retrospective cohort study on a subset of DEFUSE 3 patients recruited across 38 centers between May 2016 and May 2017 who underwent successful thrombectomy revascularization. Internal cerebral vein opacification was scored on a scale of 0-2. This metric was added to the cortical vein opacification score to derive the comprehensive VO (CVO) score from 0 to 8. Patients were stratified by favorable (ICV+) and unfavorable (ICV-) ICV scores, and similarly CVO+ and CVO-. Analyses comparing outcomes were primarily conducted by Mann-Whitney and χ tests.

Results: Forty-five patients from DEFUSE 3 were scored and dichotomized into CVO+, CVO-, ICV+, and ICV- categories, with comparable demographics. Hypoperfusion intensity ratio, a marker of tissue level collaterals, was significantly worse in the ICV- and CVO- groups (p = 0.005). ICV- alone was also associated with a larger perfusion lesion (138 ml vs 87 ml; p = 0.023). No significant differences were noted in functional and safety outcomes.

Conclusions: Impaired deep venous drainage alone may be a marker of poor tissue level collaterals and a greater degree of affected tissue in AIS-LVO patients presenting in the late-window who subsequently undergo successful revascularization.

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