TY - JOUR
T1 - Cortical Venous Filling on Dynamic Computed Tomographic Angiography
T2 - A Novel Predictor of Clinical Outcome in Patients with Acute Middle Cerebral Artery Stroke
AU - Van Den Wijngaard, Ido R.
AU - Wermer, Marieke J H
AU - Boiten, Jelis
AU - Algra, Ale
AU - Holswilder, Ghislaine
AU - Meijer, Frederick J A
AU - Dippel, Diederik W J
AU - Velthuis, Birgitta K.
AU - Majoie, Charles B L M
AU - Van Walderveen, Marianne A A
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background and Purpose-Venous flow in the downstream territory of an occluded artery may influence patient prognosis after ischemic stroke. Our aim was to study cortical venous filling (CVF) in a time-resolved manner with dynamic computed tomographic angiography and to assess the relationship with clinical outcome. Methods-Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT and whole-brain CT perfusion/dynamic CT angiography within 9 hours after stroke-onset. We defined poor outcome as a modified Rankin Scale score of ≥3. Association between the extent and velocity of CVF and poor outcome at 3 months was analyzed with Poisson-regression. Prognostic value of optimal CVF (maximum opacification of cortical veins) in addition to age, stroke severity, treatment, Alberta Stroke Program Early CT score, cerebral blood flow, and collateral status was assessed with logistic regression and summarized with the area under the curve. Results-Eighty-eight patients were included, with a mean age of 67 years. By combining the extent and velocity of optimal CVF, we observed a decreased risk of poor outcome in patients with good and fast optimal CVF, risk ratio of 0.5 (95% confidence interval, 0.3-0.7). Extent and velocity of optimal CVF had additional prognostic value (area under the curve, 0.88; 95% confidence interval, 0.77-0.98; P
AB - Background and Purpose-Venous flow in the downstream territory of an occluded artery may influence patient prognosis after ischemic stroke. Our aim was to study cortical venous filling (CVF) in a time-resolved manner with dynamic computed tomographic angiography and to assess the relationship with clinical outcome. Methods-Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT and whole-brain CT perfusion/dynamic CT angiography within 9 hours after stroke-onset. We defined poor outcome as a modified Rankin Scale score of ≥3. Association between the extent and velocity of CVF and poor outcome at 3 months was analyzed with Poisson-regression. Prognostic value of optimal CVF (maximum opacification of cortical veins) in addition to age, stroke severity, treatment, Alberta Stroke Program Early CT score, cerebral blood flow, and collateral status was assessed with logistic regression and summarized with the area under the curve. Results-Eighty-eight patients were included, with a mean age of 67 years. By combining the extent and velocity of optimal CVF, we observed a decreased risk of poor outcome in patients with good and fast optimal CVF, risk ratio of 0.5 (95% confidence interval, 0.3-0.7). Extent and velocity of optimal CVF had additional prognostic value (area under the curve, 0.88; 95% confidence interval, 0.77-0.98; P
KW - angiography
KW - brain
KW - confidence intervals
KW - prognosis
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=84959459816&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.115.012279
DO - 10.1161/STROKEAHA.115.012279
M3 - Article
C2 - 26814234
AN - SCOPUS:84955585148
SN - 0039-2499
VL - 47
SP - 762
EP - 767
JO - Stroke
JF - Stroke
IS - 3
ER -