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Absent Filling of Ipsilateral Superficial Middle Cerebral Vein Is Associated With Poor Outcome After Reperfusion

Sheng Zhang1, Yangxiao Lai1, Xinfa Ding1

  • 1From the Departments of Neurology (S.Z., Y.L., M.L.) and Radiology (X.D.), The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology, John Hunter Hospital, The University of Newcastle, NSW, Australia (M.P.); and Department of Physiology and Pharmacology, Loma Linda University, CA (J.H.Z.).

Stroke
|March 8, 2017
PubMed

Insights

Absence of superficial middle cerebral vein (SMCV) filling predicts poor neurological outcomes in stroke patients after thrombolysis, particularly when reperfusion is not achieved. This is linked to increased brain edema and worse 3-month outcomes.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Radiology

Background:

  • Cortical vein drainage, including the superficial middle cerebral vein (SMCV), vein of Trolard, and vein of Labbé, is crucial in stroke reperfusion therapy.
  • Assessing the impact of absent venous filling on neurological outcomes is important for understanding stroke pathophysiology and treatment efficacy.

Purpose of the Study:

  • To investigate the effect of cortical vein drainage, specifically the SMCV, vein of Trolard, and vein of Labbé, on neurological outcomes following reperfusion therapy in ischemic stroke patients.
  • To determine if absent filling of these cortical veins independently predicts poor neurological outcomes.

Main Methods:

  • A cohort of ischemic stroke patients undergoing intravenous thrombolysis was studied.
  • Patients had pretreatment and 24-hour computed tomographic perfusion or magnetic resonance perfusion imaging.
  • Absent ipsilateral cortical vein filling (e.g., SMCV-) was defined as no contrast filling during the venous phase on 4D CT angiography.

Main Results:

  • Absent superficial middle cerebral vein (SMCV-) filling was observed in 21.9% of patients and independently predicted poor 3-month outcomes (mRS > 2).
  • While reperfusion rates did not differ, SMCV- was associated with larger infarct volumes, higher rates of poor outcome, and death in patients without major reperfusion.
  • Absent SMCV filling correlated with increased brain edema at 24 hours, which in turn predicted poor 3-month outcomes.

Conclusions:

  • Lack of SMCV filling is a significant predictor of poor outcomes after thrombolysis, especially when reperfusion is inadequate.
  • The detrimental effect of absent SMCV filling appears primarily mediated by the development of brain edema.
  • These findings highlight the importance of venous drainage assessment in stroke management and prognostication.
Abstract

Keywords:
brain imagingedemaoutcomereperfusionvein

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