Favorable venous outflow (VO), as determined by the Cortical Vein Opacification Score (COVES), is associated with reperfusion success and good functional results in patients undergoing endovascular thrombectomy for an acute ischemic stroke due to occlusion of large vessels (AIS-LVO ) undergo study of results published in neurology.
This retrospective study included 565 consecutive patients with AIS-LVO who were treated by endovascular thrombectomy in 2 comprehensive stroke centers in Germany and the USA. Study examiners used the baseline CTA to assess collateral status (Tan scale) and VO with the COVES. They defined a favorable VR by a COVES between 3 and 6 and an unfavorable one by a COVES between 0 and 2.
The primary study result was excellent reperfusion status (defined by modified thrombolysis in cerebral infarction 2c / 3), while the secondary result was good functional results 90 days after treatment.
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Patients with favorable VO (VO +) were significantly younger (median 72 years vs. 76.5 years; P <0.001), more likely to receive intravenous tPA (70% and 40.9%; P <0.001) and had less severe symptoms of imagination (P <.001) compared to patients with an unfavorable VO.
Excellent vascular reperfusion during a thrombectomy was associated with a favorable VO in a multivariable logistic regression analysis (odds ratio [OR], 2.10; 95% Cl, 1.39-3.16; P <.001).
A multivariable binary logistic regression analysis with a secondary endpoint revealed independent associations between favorable clinical outcomes and both favorable VO + profiles (OR 8.9; 95% CI 5.3-14.9; P <0.001) and excellent vascular reperfusion status after thrombectomy (OR , 2.7.). ; 95% CI, 1.7-4.4; P <0.001).
Limitations of this study were the retrospective design and the inclusion of only patients from 2 comprehensive stroke centers, which can limit the generalizability of the results.
The investigators concluded that evaluating the venous microvascular system among other alternative blood flow pathways in patients with AIS-LVO “could be an additional useful vascular biomarker associated with endovascular treatment success and good functional outcomes”.
Disclosure: Several study authors stated links with the pharmaceutical industry. For a full list of the author’s disclosures, see the original reference.
reference
Faizy TD, Kabiri R, Christensen S, et al. Association of venous drainage profiles and successful vascular reperfusion after thrombectomy. Published online May 5, 2021. Neurology. doi: 10.1212 / WNL.0000000000012106
