The Relationship Between The Prognosis Of Patients With Middle Cerebral Artery Infarction And Filling Of Draining Veins

BackgroundIschemic stroke is the leading cause of death and disability among Chinese residents.Acute ischemic stroke is a sudden neurological dysfunction caused by focal cerebral ischemic,accompanied by acute infraction focus on imaging;which has a great impact on the quality of life for patients and their family.At present,most studied focus on the arterial system,cerebral artery and vein maintain cerebral perfusion together,cerebral vein cannot be ignored.Based on AIS patients in the middle cerebral artery（MCA）supplying area,this paper plans to study the relationship between the absence of cerebral venous filling in MCA drainage area and prognosis providing a new idea for future clinical work.ObjectiveBased on CTA,the relationship between the filling score and the total number of ipsilateral the absence of cerebral vein filling in acute ischemic stroke patients in MCA area and prognosis was investigated.Materials and methodsPatients with AIS who were hospitalized in Puyang People’s Hospital from 2019 to2021 and underwent the head and neck CTA were collected continuously.The modified Rankin Scale was used to evaluate the 90-day prognosis of patients with AIS,we can divide into good prognosis group（150 cases）（0～2 score）and poor prognosis group（120cases）（>3 score）.Based on brain reconstruction images,the filling degree of vein of Trolard,vein of Trolard,sphenoparietal sinus,basal vein of Rosenthal,deep middle cerebral vein and internal cerebral vein on the lesion side was evaluated.Among them,the single superior branch vein of CTA,2 point was defined as fully filled,1 point was defined as partial filling,0 point was defined as no filling.The scores of cerebral veins on the same side were recorded.Cerebral venous score is 0 point are defined as the absence of cerebral venous filling,and the number of ipsilateral the absence of cerebral venous filling（VOT+VOL+SPS+DMCV+BVR+ICV）is recorded（abbreviate: the total number of the absent of cerebral venous filling）.Compared with the baseline data,the number of ipsilateral the absence of cerebral venous filling,each cerebral vein score and the rate of stenosis of MCA between the two group.The independent variable of P < 0.05 in univariate analysis was included in multivariate analysis,and the influence of each variable and poor prognosis was analyzed,and ROC curve was drawn to analyze the sensitivity and specificity of the total number of the absent of cerebral venous filling in predicting poor prognosis.Result1.There was no significant difference in age,sex,smoking,drinking,past medical history（hypertension,coronary heart disease,ischemic stroke,diabetes）,biochemical indicator（triglyceride,low density lipoprotein,glucose,urea nitrogen,creatinie,uric acid）between the two groups based on baseline data（P>0.05）,and there was significant difference in national institutes of health stroke scale（NIHSS）within 24 hours of admission（P<0.05）.2.Univariate analysis show that the total number of absence of cerebral venous filling in poor prognosis group was higher than that in good prognosis group[3.0（2.0～4.0）vs1.0（1.0～2.0）],the score of VOT filling was lower than in good prognosis group[0（0～1）vs 1（1～2）],the score of VOL filling was lower than in good prognosis group[1（0～1）vs 1（1～2）],the score of SPS filling was lower than in good prognosis group[0（0～1）vs 1.5（0～2）],the score of BVR filling was lower than in good prognosis group[1（0～1）vs 1（1～2）],the score of DMCV filling was lower than in good prognosis group[0（0～1）vs 0（1～2）],the stenosis rate of MCA was higher than that in good prognosis group[80.0（60.0～100.0）vs30.0（17.0～60.0）],the rate of the low Alberta stroke program early CT score（ASPECTS）（≤7 scores）was higher than that in good prognosis group[66（55.0）vs45（30.0）],the score of discharge NIHSS was higher than that in good prognosis group [5.0（3.0～7.0）vs1.0（0.0～2.0）],and the difference was significant（P<0.05）.3.Multivariate analysis show that the total number of the absent of cerebral venous filling,the stenosis rate of MCA,NIHSS within 24 hours of admission,NIHSS at discharge are risk factors for poor prognosis.4.For the total number of the absent of cerebral venous filling>2 in predicting the poor prognosis,the sensitivity was 63.3% and the specificity was 84.7%,the area under the ROC curve（AUC）was 0.780（95%CI 0.726～0.828）.ConclusionThe score of ipsilateral of cerebral venous filling may be related to the poor prognosis of AIS patients;The total number of absence of cerebral venous filling is a risk factor for the poor prognosis of AIS of MCA blood supply area.What’s more,the total number of the absent of cerebral venous filling>2,which means poor prognosis.