| PurposeVenous flow in the downstream territory of an occluded artery may influence prognosis in patients with acute ischemic stroke(AIS). Our aim was to evaluate the status of cortical venous filling (CVF) of patients with AIS by dynamic computed tomographic angiography (CTA) and to analyze the relationship between CVF and clinical outcome after intravenous thrombolysis (IVT).MethodsWe retrospectively analyzed computed tomographic perfusion (CTP) imaging of AIS patients with middle cerebral artery (MCA) Ml segment occlusion undergoing IVT, and reconstructed the images for dynamic CTA in the Second Affiliated Hospital, Zhejiang University School of Medicine from June 2009 to October 2015. The poor extent of cortical venous filling was assessed at the time points of venous peak phase based on dynamic CTA images and defined as<50% of cortical veins in the affected hemisphere in comparison with the nonaffected hemisphere. We defined poor outcome as a modified Rankin Scale score (mRS) of≥3. Arterial Occlusive Lesion (AOL)^ 2 was defined as recanalization. The European Cooperative Acute Stroke Study (ECASS) criteria was used to define hemorrhagic transformation (HT).ResultsA total of 82 patients with AIS were included, with a mean age of 69 years. Compared with the good extent of CVF group, patients with poor extent of CVF were more likely to have poor outcome (3-months mRS scored3)(62% vs 7%, p=0.001). After multi-variate analysis, the poor extent of CVF (OR=8.514,95%CI=1.635-44.347, p=0.011) and baseline NIHSS(OR=1.165,95%CI=1.016-1.335, p=0.029) were independent predictors of poor outcome. There was no difference in rate of recanalization or HT between groups with different baseline venous state (p>0.05).ConclusionThe extent of CVF is useful to identify patients with acute MCA stroke after IVT, as assessed by dynamic CTA. The patients with poor extent of CVF have a higher risk of poor clinical outcome. |
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