Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

Christian Heitkamp; Laurens Winkelmeier; Jeremy J. Heit; Gregory W. Albers; Maarten G. Lansberg; Helge Kniep; Gabriel Broocks; Christian Paul Stracke; Maximilian Schell; Adrien Guenego; Daniel Paech; Max Wintermark; Jens Fiehler; Tobias D. Faizy

doi:10.1177/23969873231208277

Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

Christian Heitkamp, Laurens Winkelmeier, Jeremy J. Heit, Gregory W. Albers, Maarten G. Lansberg, Helge Kniep, Gabriel Broocks, Christian Paul Stracke, Maximilian Schell, Adrien Guenego, Daniel Paech, Max Wintermark, Jens Fiehler, Tobias D. Faizy

Neuroradiology

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: Early neurological deterioration (END) is associated with poor outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Causes of END after mechanical thrombectomy (MT) include unsuccessful recanalization and reperfusion hemorrhages. However, little is known about END excluding the aforementioned causes. We aimed to investigate factors associated with unexplained END (END_unexplained) with regard to the cerebral collateral status. Patients and Methods: Multicenter retrospective study of AIS-LVO patients with successful MT (mTICI 2b-3). On admission CT angiography (CTA), pial arterial collaterals and venous outflow (VO) were assessed using the modified Tan-Scale and the Cortical Vein Opacification Score (COVES), respectively. END_unexplained was defined as an increase in NIHSS score of ⩾ 4 within the first 24 hours after MT without parenchymal hemorrhage on follow-up imaging. Multivariable regression analyses were performed to examine factors of END_unexplained and unfavorable functional outcome (modified Rankin Scale score 3-6). Results: A total of 620 patients met the inclusion criteria. END_unexplained occurred in 10% of patients. While there was no significant difference in pial arterial collaterals, patients with END_unexplained exhibited more often unfavorable VO (81% vs. 53%; P < 0.001). Unfavorable VO (aOR [95% CI]; 2.56 [1.02-6.40]; P = 0.045) was an independent predictor of END_unexplained. END_unexplained was independently associated with unfavorable functional outcomes at 90 days (aOR [95% CI]; 6.25 [2.06-18.94]; P = 0.001). Discussion and Conclusion: Unfavorable VO on admission CTA was associated with END_unexplained. END_unexplained was independently linked to unfavorable functional outcomes at 90 days. Identifying AIS-LVO patients at risk of END_unexplained may help to select patients for intensified monitoring and guide to optimal treatment regimes.

Original language	English (US)
Pages (from-to)	162-171
Number of pages	10
Journal	European Stroke Journal
Volume	9
Issue number	1
DOIs	https://doi.org/10.1177/23969873231208277
State	Published - Mar 2024

Keywords

CT angiography
Stroke
angiography
blood flow
thrombectomy

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine

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10.1177/23969873231208277

Cite this

Heitkamp, C., Winkelmeier, L., Heit, J. J., Albers, G. W., Lansberg, M. G., Kniep, H., Broocks, G., Stracke, C. P., Schell, M., Guenego, A., Paech, D., Wintermark, M., Fiehler, J., & Faizy, T. D. (2024). Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow. European Stroke Journal, 9(1), 162-171. https://doi.org/10.1177/23969873231208277

Heitkamp, C, Winkelmeier, L, Heit, JJ, Albers, GW, Lansberg, MG, Kniep, H, Broocks, G, Stracke, CP, Schell, M, Guenego, A, Paech, D, Wintermark, M, Fiehler, J & Faizy, TD 2024, 'Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow', European Stroke Journal, vol. 9, no. 1, pp. 162-171. https://doi.org/10.1177/23969873231208277

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title = "Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow",

abstract = "Introduction: Early neurological deterioration (END) is associated with poor outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Causes of END after mechanical thrombectomy (MT) include unsuccessful recanalization and reperfusion hemorrhages. However, little is known about END excluding the aforementioned causes. We aimed to investigate factors associated with unexplained END (ENDunexplained) with regard to the cerebral collateral status. Patients and Methods: Multicenter retrospective study of AIS-LVO patients with successful MT (mTICI 2b-3). On admission CT angiography (CTA), pial arterial collaterals and venous outflow (VO) were assessed using the modified Tan-Scale and the Cortical Vein Opacification Score (COVES), respectively. ENDunexplained was defined as an increase in NIHSS score of ⩾ 4 within the first 24 hours after MT without parenchymal hemorrhage on follow-up imaging. Multivariable regression analyses were performed to examine factors of ENDunexplained and unfavorable functional outcome (modified Rankin Scale score 3-6). Results: A total of 620 patients met the inclusion criteria. ENDunexplained occurred in 10% of patients. While there was no significant difference in pial arterial collaterals, patients with ENDunexplained exhibited more often unfavorable VO (81% vs. 53%; P < 0.001). Unfavorable VO (aOR [95% CI]; 2.56 [1.02-6.40]; P = 0.045) was an independent predictor of ENDunexplained. ENDunexplained was independently associated with unfavorable functional outcomes at 90 days (aOR [95% CI]; 6.25 [2.06-18.94]; P = 0.001). Discussion and Conclusion: Unfavorable VO on admission CTA was associated with ENDunexplained. ENDunexplained was independently linked to unfavorable functional outcomes at 90 days. Identifying AIS-LVO patients at risk of ENDunexplained may help to select patients for intensified monitoring and guide to optimal treatment regimes.",

keywords = "CT angiography, Stroke, angiography, blood flow, thrombectomy",

author = "Christian Heitkamp and Laurens Winkelmeier and Heit, {Jeremy J.} and Albers, {Gregory W.} and Lansberg, {Maarten G.} and Helge Kniep and Gabriel Broocks and Stracke, {Christian Paul} and Maximilian Schell and Adrien Guenego and Daniel Paech and Max Wintermark and Jens Fiehler and Faizy, {Tobias D.}",

note = "Publisher Copyright: {\textcopyright} European Stroke Organisation 2023.",

year = "2024",

month = mar,

doi = "10.1177/23969873231208277",

language = "English (US)",

volume = "9",

pages = "162--171",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publications Inc.",

number = "1",

}

TY - JOUR

T1 - Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

AU - Heitkamp, Christian

AU - Winkelmeier, Laurens

AU - Heit, Jeremy J.

AU - Albers, Gregory W.

AU - Lansberg, Maarten G.

AU - Kniep, Helge

AU - Broocks, Gabriel

AU - Stracke, Christian Paul

AU - Schell, Maximilian

AU - Guenego, Adrien

AU - Paech, Daniel

AU - Wintermark, Max

AU - Fiehler, Jens

AU - Faizy, Tobias D.

N1 - Publisher Copyright: © European Stroke Organisation 2023.

PY - 2024/3

Y1 - 2024/3

N2 - Introduction: Early neurological deterioration (END) is associated with poor outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Causes of END after mechanical thrombectomy (MT) include unsuccessful recanalization and reperfusion hemorrhages. However, little is known about END excluding the aforementioned causes. We aimed to investigate factors associated with unexplained END (ENDunexplained) with regard to the cerebral collateral status. Patients and Methods: Multicenter retrospective study of AIS-LVO patients with successful MT (mTICI 2b-3). On admission CT angiography (CTA), pial arterial collaterals and venous outflow (VO) were assessed using the modified Tan-Scale and the Cortical Vein Opacification Score (COVES), respectively. ENDunexplained was defined as an increase in NIHSS score of ⩾ 4 within the first 24 hours after MT without parenchymal hemorrhage on follow-up imaging. Multivariable regression analyses were performed to examine factors of ENDunexplained and unfavorable functional outcome (modified Rankin Scale score 3-6). Results: A total of 620 patients met the inclusion criteria. ENDunexplained occurred in 10% of patients. While there was no significant difference in pial arterial collaterals, patients with ENDunexplained exhibited more often unfavorable VO (81% vs. 53%; P < 0.001). Unfavorable VO (aOR [95% CI]; 2.56 [1.02-6.40]; P = 0.045) was an independent predictor of ENDunexplained. ENDunexplained was independently associated with unfavorable functional outcomes at 90 days (aOR [95% CI]; 6.25 [2.06-18.94]; P = 0.001). Discussion and Conclusion: Unfavorable VO on admission CTA was associated with ENDunexplained. ENDunexplained was independently linked to unfavorable functional outcomes at 90 days. Identifying AIS-LVO patients at risk of ENDunexplained may help to select patients for intensified monitoring and guide to optimal treatment regimes.

AB - Introduction: Early neurological deterioration (END) is associated with poor outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Causes of END after mechanical thrombectomy (MT) include unsuccessful recanalization and reperfusion hemorrhages. However, little is known about END excluding the aforementioned causes. We aimed to investigate factors associated with unexplained END (ENDunexplained) with regard to the cerebral collateral status. Patients and Methods: Multicenter retrospective study of AIS-LVO patients with successful MT (mTICI 2b-3). On admission CT angiography (CTA), pial arterial collaterals and venous outflow (VO) were assessed using the modified Tan-Scale and the Cortical Vein Opacification Score (COVES), respectively. ENDunexplained was defined as an increase in NIHSS score of ⩾ 4 within the first 24 hours after MT without parenchymal hemorrhage on follow-up imaging. Multivariable regression analyses were performed to examine factors of ENDunexplained and unfavorable functional outcome (modified Rankin Scale score 3-6). Results: A total of 620 patients met the inclusion criteria. ENDunexplained occurred in 10% of patients. While there was no significant difference in pial arterial collaterals, patients with ENDunexplained exhibited more often unfavorable VO (81% vs. 53%; P < 0.001). Unfavorable VO (aOR [95% CI]; 2.56 [1.02-6.40]; P = 0.045) was an independent predictor of ENDunexplained. ENDunexplained was independently associated with unfavorable functional outcomes at 90 days (aOR [95% CI]; 6.25 [2.06-18.94]; P = 0.001). Discussion and Conclusion: Unfavorable VO on admission CTA was associated with ENDunexplained. ENDunexplained was independently linked to unfavorable functional outcomes at 90 days. Identifying AIS-LVO patients at risk of ENDunexplained may help to select patients for intensified monitoring and guide to optimal treatment regimes.

KW - CT angiography

KW - Stroke

KW - angiography

KW - blood flow

KW - thrombectomy

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JO - European Stroke Journal

JF - European Stroke Journal

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Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

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