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Updated: May 9, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Prognostic evaluation based on cortical vein score difference in stroke.

Rajsrinivas Parthasarathy¹, Mahesh Kate, Jeremy L Rempel

¹From the Departments of Medicine (R.P., M.K., T.J., K.S.B., A.S.) and Radiology and Diagnostic Imaging (J.L.R.), University of Alberta, Edmonton, Alberta, Canada; and UCLA Stroke Center, Los Angeles, CA (D.S.L.).

|July 27, 2013

Summary

Assessing venous drainage patterns using computed tomography angiography can predict stroke outcomes. A novel score evaluating cortical vein enhancement accurately identifies patients with poor prognoses in acute ischemic stroke.

Keywords:

angiography brain ischemia cerebral veins collateral circulation perfusion stroke

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Last Updated: May 9, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Area of Science:

Neurology
Radiology
Medical Imaging

Background:

Acute ischemic stroke management relies on imaging to assess arterial collaterals, penumbra, and infarct core.
Existing imaging methods have limitations in fully predicting stroke outcomes.
Venous drainage patterns offer a potential new avenue for prognostication.

Purpose of the Study:

To identify superficial and deep venous drainage patterns.
To determine if these patterns predict outcomes in patients with anterior circulation arterial occlusion.
To introduce and validate a novel scoring system for venous enhancement.

Main Methods:

Observational study using computed tomography (CT) angiography.
Detailed assessment of venous drainage in 39 patients with proximal anterior circulation arterial occlusion.
Scoring of principal cortical and deep veins for contrast enhancement.
Analysis of the Prognostic Evaluation based on Cortical vein score difference In Stroke (PECVIST) score against 90-day modified Rankin Scale outcomes.

Main Results:

A PECVIST score of 4 to 8 accurately predicted poor outcomes (modified Rankin Scale 3-6) with an odds ratio of 20.53 (P<0.001).
In multivariate analysis, a PECVIST score of 4-8 (OR, 23.598; P=0.009) and elevated National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.423; P=0.023) were independent predictors of poor outcome.
The study included 39 patients.

Conclusions:

The PECVIST score, a novel measure of venous enhancement on CT angiography, accurately predicts clinical outcomes in acute ischemic stroke.
Venous features on CT angiography provide valuable additional characterization of collateral perfusion.
This imaging approach enhances prognostication in acute ischemic stroke patients.