The Relationship Between Deep Cerebral Veins And Outcome After Intravenous Thrombolysis In Acute Ischemic Stroke Patients

Background and purposeThe impact of deep cerebral veins on neurological outcome after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS)is unclear.We investigated the relationship between the appearance of deep cerebral veins on susceptibility-weighted imaging(SWI)and neurological outcome in patients who underwent thrombolysis.Materials and methodsWe retrospectively reviewed our prospectively collected database for AIS patients who were admitted to our center between June 2011 and July 2015.Consecutive acute ischemic stroke patients who who had pretreatment SWI and receivedintravenous thrombolysis(IVT)within 6 hours were retrospectively studied.We evaluated thalamostriate vein(TSV),septal vein(SV)and internal cerebral vein(ICV)on the reconstructed SWIand calculated the signal difference ratio(defined as the relative difference in signal intensity between the ipsilateral and contralateral vein).Successful reperfusion was defined as>70%reduction in hypoperfusion volume between pretreatment and 24-hour perfusion imaging.Patients were dichotomized into good(modified Rankin Scale,mRS<2)versus poor outcome(mRS>2)at 90 days.ResultOnly signal difference ratio of the TSV was significantly associated with poor outcome(3-month modified Rankin scale score>2)(p= 0.25,p=0.008).The optimal threshold was relative hypointensity of the ipsilateral vein>4.8%(sensitivity of 53.7%and specificity of 80.9%).We defined a signal difference ratio of the TSV>5%as"ipsilateral prominent TSV(IPTSV)".IPTSV was seen in 35 patients(32.1%).Patients with IPTSV were more likely to have poor outcome(62.9%vs 25.7%,OR=3.66 95%CI 1.25-10.68,p=0.02),and lower rate of successful reperfusion(reperfusion rate>70%)(37.5%vs 60.0%,OR=0.35 95%CI 0.13-0.92,p=0.03),compared with those without ipsilateral prominent TSV.However,patients with ipsilateral prominent TSV,were still less likely to experience poor outcome when reperfusion was achieved compared to when reperfusion did not occur(80.0%vs 44.4%,p=0.04).ConclusionPretreatment ipsilateral prominent TSV was associated with reduced reperfusion after thrombolysis and poor outcome.More intensive reperfusion approaches may be required for patients with ipsilateral prominent TSV.