Early venous filling after reperfusion therapy in acute ischemic stroke.
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Brain Ischemia
/ diagnostic imaging
Cerebral Angiography
Cerebral Veins
/ diagnostic imaging
Cerebrovascular Circulation
Diffusion Magnetic Resonance Imaging
Female
Humans
Intracranial Hemorrhages
/ diagnostic imaging
Male
Middle Aged
Postoperative Hemorrhage
/ diagnostic imaging
Prospective Studies
Recovery of Function
Risk Factors
Stroke
/ diagnostic imaging
Thrombectomy
/ adverse effects
Time Factors
Treatment Outcome
Acute ischemic stroke
Digital subtraction angiography
Hyperperfusion
Reperfusion therapy
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
09
03
2020
revised:
27
04
2020
accepted:
29
04
2020
entrez:
22
7
2020
pubmed:
22
7
2020
medline:
31
10
2020
Statut:
ppublish
Résumé
Early venous filling after endovascular mechanical thrombectomy in acute ischemic stroke (AIS) is a specific finding that may serve as a biomarker for intracranial hemorrhage. However, the pathophysiology of early venous filling and postoperative hemorrhage remains unclear. The aim of this study was to investigate correlation between early venous filling and various factors involving patient demographics and perioperative imaging. We prospectively analyzed 35 patients with AIS due to cardioembolism (CE) who underwent successful acute revascularization (TICI ≥2). Ischemic lesions were scored by magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Outcomes were assessed using the modified Rankin Scale (mRS) 90 days after stroke onset. Blood flow analysis was evaluated by MRI with arterial spin labeling (ASL). Early venous filling was assessed by digital subtraction angiography (DSA). Univariate analysis was performed to investigate correlations between early venous filling and patient demographics and imaging findings. Early venous filling was observed in 22 of 35 (66%) patients after reperfusion therapy. There was a significant correlation between early venous filling and DWI-ASPECTS (6.2 vs 8.8, p=0.0003), outcome (5 vs 9, p=0.006), hyperperfusion (17 vs 1, p< 0.0001), and hemorrhagic transformation (17 vs 1, p=0.005). This comprehensive study revealed that early venous filling after reperfusion therapy is associated with postoperative hyperperfusion. Early venous filling may be a marker of the process of hyperperfusion, leading to hemorrhage and an unfavorable outcome. Detection of early venous filling may be an important finding on DSA for subsequent intensive perioperative management.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Early venous filling after endovascular mechanical thrombectomy in acute ischemic stroke (AIS) is a specific finding that may serve as a biomarker for intracranial hemorrhage. However, the pathophysiology of early venous filling and postoperative hemorrhage remains unclear. The aim of this study was to investigate correlation between early venous filling and various factors involving patient demographics and perioperative imaging.
METHODS
METHODS
We prospectively analyzed 35 patients with AIS due to cardioembolism (CE) who underwent successful acute revascularization (TICI ≥2). Ischemic lesions were scored by magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Outcomes were assessed using the modified Rankin Scale (mRS) 90 days after stroke onset. Blood flow analysis was evaluated by MRI with arterial spin labeling (ASL). Early venous filling was assessed by digital subtraction angiography (DSA). Univariate analysis was performed to investigate correlations between early venous filling and patient demographics and imaging findings.
RESULTS
RESULTS
Early venous filling was observed in 22 of 35 (66%) patients after reperfusion therapy. There was a significant correlation between early venous filling and DWI-ASPECTS (6.2 vs 8.8, p=0.0003), outcome (5 vs 9, p=0.006), hyperperfusion (17 vs 1, p< 0.0001), and hemorrhagic transformation (17 vs 1, p=0.005).
CONCLUSIONS
CONCLUSIONS
This comprehensive study revealed that early venous filling after reperfusion therapy is associated with postoperative hyperperfusion. Early venous filling may be a marker of the process of hyperperfusion, leading to hemorrhage and an unfavorable outcome. Detection of early venous filling may be an important finding on DSA for subsequent intensive perioperative management.
Identifiants
pubmed: 32689637
pii: S1052-3057(20)30332-3
doi: 10.1016/j.jstrokecerebrovasdis.2020.104926
pii:
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
104926Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.