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Microvascular dysfunction associated with unfavorable venous outflow in acute ischemic stroke patients.

ABSTRACT: Unfavorable venous outflow (VO) is associated with cerebral edema, which represents microvascular dysfunction. This study estimated the relationship between VO and microvascular function in acute ischemic stroke patients. We retrospectively included 102 MCA/ICA occluded patients with anterior circulation infarction who underwent reperfusion therapy between July 2017 and April 2022. Unfavorable VO was defined as a cortical vein opacification score of 0-3 and favorable VO as that of 4-6. The clinical characteristics, collateral status, microvascular integrity, and outcomes were compared between patients with favorable and unfavorable VO. Multivariate analysis and receiver operator characteristic (ROC) analysis were used. The patients with unfavorable VO had higher extravascular-extracellular volume fraction (Ve) in the infarct core and a lower percentage of robust arterial collateral circulation. ROC analysis revealed that Ve in the infarct core predicts unfavorable VO (AUC = 0.67, sensitivity = 65.08%, specificity = 69.23%). The higher Ve in the infarct core (odds ratio = 1.011, 95% CI = 1.000-1.021, P = 0.046) and poor arterial collateral flow (odds ratio = 0.102, 95% CI = 0.032-0.327, P < 0.001) were independent predictors of unfavorable VO. This suggests that microvascular dysfunction may be one of the mechanisms underlying impaired VO.

SUBMITTER: Li X

PROVIDER: S-EPMC10638995 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Microvascular dysfunction associated with unfavorable venous outflow in acute ischemic stroke patients.

Li Xiaoshuang X Lin Liping L Zhang Jian J Fan Yuhua Y Xing Shihui S Jiang Li L Yang Zhiyun Z Zhao Jing J Li Jingjing J

Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism 20230327 2_suppl

Unfavorable venous outflow (VO) is associated with cerebral edema, which represents microvascular dysfunction. This study estimated the relationship between VO and microvascular function in acute ischemic stroke patients. We retrospectively included 102 MCA/ICA occluded patients with anterior circulation infarction who underwent reperfusion therapy between July 2017 and April 2022. Unfavorable VO was defined as a cortical vein opacification score of 0-3 and favorable VO as that of 4-6. The clini ...[more]

PMID: 36967711

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Project description:BackgroundThe presence of early venous filling (EVF) post-mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients has been observed, yet its prognostic value for clinical outcomes remains underexplored. This study aimed to assess the correlation between EVF and poor clinical outcomes in AIS patients who underwent MT.Materials and methodsThis retrospective analysis included AIS patients with large vessel occlusions treated with MT at the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to June 2023. The primary outcome was mRS at 90 days, secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and malignant brain edema. The study used inverse probability weighting for balancing baseline characteristics and employed univariate and multivariate logistic regression analyses to explore the association between EVF and clinical outcomes. G*Power was used to calculate the sample size.ResultsAmong 307 patients, 75 (24.4%) presented with EVF. Patients with EVF had significantly higher rates of unfavorable outcomes at 90 days (76.00% vs. 46.12%, P < 0.001). Multivariate analysis revealed significant associations between EVF and unfavorable outcome (odds ratio [OR] = 2.69, 95%CI [1.37-5.26], P = 0.004), hemorrhagic transformation (OR = 3.11, 95%CI [1.73-5.62], P < 0.001), symptomatic intracranial hemorrhage (OR = 3.24, 95%CI 1.42 to 7.37, P = 0.005), and malignant brain edema (OR = 3.06, 95%CI [1.56-6.01], P = 0.001). Stratified analysis showed EVF group with a baseline Alberta Stroke Program Early CT (ASPECT) score of ≤ 8 exhibited a higher risk of unfavorable outcomes compared with patients in the non-EVF group (OR = 2.64, 95%CI [1.03-6.73], P = 0.042). Mediation analysis indicated that malignant brain edema accounted for 35.42% of the correlation between EVF and unfavorable outcomes.ConclusionsThis study establishes EVF as an independent risk factor for unfavorable outcomes after MT in AIS. Therefore, EVF in conjunction with a low ASPECT score provides essential insights for identifying patients at high risk for unfavorable outcomes.

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Microvascular dysfunction associated with unfavorable venous outflow in acute ischemic stroke patients.

Publications

Microvascular dysfunction associated with unfavorable venous outflow in acute ischemic stroke patients.

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