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Time-resolved assessment of cortical venous drainage on multiphase CT angiography in patients with acute ischemic stroke

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

Cortical vein opacification is not routinely assessed in patients presenting with acute ischemic stroke (AIS), and the value of temporal assessment of venous outflow is not known. We evaluated the utility of assessing cortical venous drainage over time using multiphase CT angiography (mCTA).

Methods

Cortical venous drainage was assessed in patients from the Precise and Rapid Assessment of Collaterals Using Multi-Phase CTA in the Triage of Patients With Acute Ischemic Stroke for IA Therapy prospective multicenter cohort study of patients with symptoms of AIS with ICA and/or middle cerebral artery occlusion on baseline mCTA. Opacification of vein of Labbe, sphenoparietal sinus, superficial middle cerebral vein, and vein of Trolard of the affected hemisphere was graded as no (0), partial (1), or full (2) opacification in each mCTA phase. The venous opacification scores for each phase were added to generate a total venous score (TVS) (range 0–24). Primary outcome was 90-day modified Rankin score. Repeated measures analysis was used to assess the effect of phase timing on venous score on outcome.

Results

Of 432 patients, 284 (65.7%) had proximal arterial occlusions. Median venous opacification score per phase (range 0–8) was 3 (IQR 1–6) in the first phase and increased in the second and third phases [median (IQR): 6 (5–8) and 8 (6–8), respectively] of the mCTA. In a multivariable analysis adjusting for age, baseline National Institutes of Health Stroke Scale, and Alberta stroke program early CT score, a significant association between TVS and 90-day mRS was noted ([adjusted cOR for TVS 6–11: 0.16 (95% CI 0.05–0.51); TVS 12–17: 0.18 (95% CI 0.06–0.57); TVS 18–24: 0.20 (0.06–0.63)]. Repeated measures analysis of venous scores from all three phases showed a significant effect of time/phase on TVS (p < 0.001).

Conclusion

This study concludes that venous opacification over time on multiphase CTA is associated with 90-day clinical outcome. There was however no added benefit of venous scoring vis-a-vis arterial collateral assessment in predicting outcome.

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Data availability

Data will be made available on reasonable request.

Code availability

Data will be made available on reasonable request.

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Authors and Affiliations

  1. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada

    Nishita Singh, Mohamed Najm, Bijoy K. Menon & Mohammed Almekhlafi

  2. Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada

    Fouzi Bala, Mayank Goyal, Bijoy K. Menon & Mohammed Almekhlafi

  3. Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnamsi, Gyeonggi-do, Republic of Korea

    B. J. Kim

  4. Department of Neurology, Chosun University Hospital, Gwangju, Republic of Korea

    Seong Hwan Ahn

  5. Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy

    Enrico Fainardi

  6. Stroke Unit, Department of Neurology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Barcelona, Spain

    Marta Rubiera

  7. Department of Clinical Neurosciences, University of Western Ontario, London Health Sciences Centre, London, Canada

    Alexander V. Khaw

  8. Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy

    Andrea Zini

Authors
  1. Nishita Singh
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  2. Fouzi Bala
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  3. B. J. Kim
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  4. Mohamed Najm
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  6. Enrico Fainardi
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  7. Marta Rubiera
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  9. Andrea Zini
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  10. Mayank Goyal
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  11. Bijoy K. Menon
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  12. Mohammed Almekhlafi
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Corresponding author

Correspondence to Nishita Singh.

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Conflict of interest statement

We declare that we have no conflict of interest.

Disclosures

Dr Fouzi Bala is supported by La Société Française de Neuroradiologie and La Société Française de Radiologie.

Mayank Goyal received personal fees (Mentice, Medtronic, MicroVention, and Stryker outside the submitted work) and patent (systems of acute stroke diagnosis).

Andrea Zini received consulting fees from Stryker, Boehringer-Ingelheim, and Alexion and speaker honoraria from Cerenovus.

Others: none

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Singh, N., Bala, F., Kim, B.J. et al. Time-resolved assessment of cortical venous drainage on multiphase CT angiography in patients with acute ischemic stroke. Neuroradiology 64, 897–903 (2022). https://doi.org/10.1007/s00234-021-02837-1

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  • DOI: https://doi.org/10.1007/s00234-021-02837-1

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