The Relationship Between Absent Filling Of Ipsilateral Superficial Middle Cerebral Vein And Outcome After Intravenous Thrombolysis In Ischemic Stroke Patient

ObjectiveThe aim of this study was to explicit the effect of drainage state of superficial middle cerebral vein (SMCV) on the subsequent neurological outcomes having intravenous thrombolysis.MethodsWe retrospectively reviewed our prospectively collected database for AIS patients who were admitted to our center between June 2011 and November 2015. Consecutive acute ischemic stroke patients who underwent CT perfusion (CTP) before intravenous thrombolysis (IVT) were retrospectively studied. We defined no contrast filling of superficial middle cerebral vein across the whole venous phase in stroke hemisphere as absence of SMCV, while the appearance of contrast flow in tSMCV at any time point in venous phase in both hemispheres was defined as the presence SMCV. Hemorrhagic transformation (HT) was identified on 24-hours NCCT or SWI images according The European Cooperative Acute Stroke Study (ECASS). Patients with Arterial Occlusive Lesion (AOL) score of 2 or greater were defined as recanalization.Patients were dichotomized into good (mRS≤2) versus poor outcome (mRS> 2) at 90 days.ResultsIn total,228 patients with acute ischemic stroke (AIS) were included. On the baseline dynamic CT angiography (CTA), the absence of ipsilateral superficial middle cerebral vein (SMCV) was seen in 50 patients (21.9%).The absence of ipsilateral SMCV was correlated with poor outcome (68.0% VS 41.0%, x2=11.416, p=0.001).The absence of ipsilateral SMCV (OR=2.577,95%CI=1.162-5.714, p=0.020) and baseline NIHSS (OR=1.234,95%CI=1.160-1.312, p=0.000) were independently predictors of poor outcome.Among 228 patients included in this study,82 patients (36.0%) had the occlusion of ICA or MCA M1 segment, of whom 21 patients (25.6%) with absent ipsilateral SMCV.The absence of ipsilateral SMCV was presented more in patients with no recanalization (68.9% VS 42.9%, x2=4.490, p=0.034) and poor outcome (90.5% VS 55.7%, x2=8.247, p=0.004).The absence of ipsilateral. SMCV (OR=7.334, 95%CI=1.004-53.562, p=0.050) and baseline NIHSS (OR=1.234 95%CI=1.160-1.312, p=0.000) were independently predictors of poor outcome.While the absence of ipsilateral SMCV(OR=0.557,95%CI=0.167-1.853, p=0.340)wasn’t independently predictors of no recanalization.The absence of ipsilateral SMCV- did not predict HT (38.1% VS 41.0%, x 2=0.054, p=0.816)in patients with LAO. For patients with LAO who achieved recanalization,the absence of ipsilateral SMCV wasn’t presented more in patients with poor outcome (77.8% VS 40.5%, x2=4.139, p=0.066) any more.ConclusionThe absent filling of ipsilateral SMCV independently associated with poor outcome of patient. Successful recanalization would still be the ultimate goal of reperfusion therapy, especially for patients with absent filling ipsilateral SMCV after acute ischemic stroke.