Vijay K Sharma1, Leonard L L Yeo2, Hock L Teoh2, Liang Shen3, Bernard P L Chan2, Raymond C Seet2, Aftab Ahmad2, Vincent F Chong4, Prakash R Paliwal2. 1. Division of Neurology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: drvijay@singnet.com.sg. 2. Division of Neurology, Department of Medicine, National University Health System, Singapore. 3. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 4. Department of Diagnostic Imaging, National University Health System, Singapore.
Abstract
BACKGROUND: Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other, and consistently seen on computed tomography angiography (CTA). Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of internal carotid artery or middle cerebral artery. Because systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome. METHODS: Consecutive AIS patients treated with intravenous thrombolysis between 2007 and 2010 were included. ICV asymmetry was assessed by 2 independent blinded stroke neurologists/neuroradiologists. Functional outcome was assessed by the modified Rankin Scale (mRS) at 3 months, dichotomized as good (0-1) and poor (2-6). Data were analyzed for predictors of functional outcome. RESULTS: Of 2238 patients with AIS, 226 (10.1%) anterior circulation AIS patients received intravenous thrombolysis. The median age was 65 years (range 19-92), 44% were men, and median National Institutes of Health Stroke Scale (NIHSS) score was 16 points (range 4-32). Hypertension was the commonest risk factor in 173 (76.5%) patients, whereas 78 (34.5%) had atrial fibrillation. ICV asymmetry on follow-up CTA was assessed in 103 (45.5%) patients. Admission NIHSS score (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.079-1.201, P = .046), change in NIHSS score during first 24 hours (OR .737; 95% CI .672-.807, P < .0001), and ICV asymmetry on follow-up CTA (OR 20.3; 95% CI 4.67-52.07, P < .0001) independently predicted poor outcome at 3 months. CONCLUSIONS: ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.
BACKGROUND: Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other, and consistently seen on computed tomography angiography (CTA). Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of internal carotid artery or middle cerebral artery. Because systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome. METHODS: Consecutive AISpatients treated with intravenous thrombolysis between 2007 and 2010 were included. ICV asymmetry was assessed by 2 independent blinded stroke neurologists/neuroradiologists. Functional outcome was assessed by the modified Rankin Scale (mRS) at 3 months, dichotomized as good (0-1) and poor (2-6). Data were analyzed for predictors of functional outcome. RESULTS: Of 2238 patients with AIS, 226 (10.1%) anterior circulation AISpatients received intravenous thrombolysis. The median age was 65 years (range 19-92), 44% were men, and median National Institutes of Health Stroke Scale (NIHSS) score was 16 points (range 4-32). Hypertension was the commonest risk factor in 173 (76.5%) patients, whereas 78 (34.5%) had atrial fibrillation. ICV asymmetry on follow-up CTA was assessed in 103 (45.5%) patients. Admission NIHSS score (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.079-1.201, P = .046), change in NIHSS score during first 24 hours (OR .737; 95% CI .672-.807, P < .0001), and ICV asymmetry on follow-up CTA (OR 20.3; 95% CI 4.67-52.07, P < .0001) independently predicted poor outcome at 3 months. CONCLUSIONS: ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.
Authors: Yi Chen; Sheng Zhang; Shenqiang Yan; Meixia Zhang; Ruiting Zhang; Feina Shi; David S Liebeskind; Mark Parsons; Min Lou Journal: Front Neurol Date: 2022-05-10 Impact factor: 4.086
Authors: L L L Yeo; P Paliwal; H L Teoh; R C Seet; B P Chan; E Ting; N Venketasubramanian; W K Leow; B Wakerley; Y Kusama; R Rathakrishnan; V K Sharma Journal: AJNR Am J Neuroradiol Date: 2014-10-16 Impact factor: 3.825