Difference between arterial and venous peak optical density after thrombectomy is associated with functional outcomes

Area of Science:

• Neuroscience
• Medical Imaging
• Interventional Neurology

Background:

• Digital subtraction angiography (DSA) is utilized to assess cerebral circulation function.
• Peak optical density (POD) measurements from DSA can evaluate contrast medium density.
• Understanding reperfusion dynamics post-thrombectomy is crucial for functional recovery.

Purpose of the Study:

• To investigate the impact of arteriovenous peak optical density (POD) differences after thrombectomy on patient functional outcomes.
• To determine if the POD difference between the internal carotid artery (ICA) and cortical veins (CV) is a predictor of recovery.
• To analyze the relationship between cerebral reperfusion indicators and functional outcomes following large vessel occlusion thrombectomy.

Main Methods:

• Retrospective review of 166 acute ischemic stroke patients who underwent thrombectomy for large vessel occlusion.
• DSA images were analyzed using ImageJ software to quantify POD of the ICA and cortical veins (POD_VA).
• The POD difference between ICA and cortical veins (POD_ICA-CV) was calculated; good functional outcome was defined as modified Rankin Scale score 0-2 at 90 days.

Main Results:

• Patients achieving good functional outcomes exhibited significantly lower ipsilateral POD_VA and POD_ICA-CV compared to those with poor outcomes (p < 0.001 for both).
• Multivariable logistic regression confirmed that lower ipsilateral POD_VA (OR 0.991) and POD_ICA-CV (OR 0.975) were independently associated with good functional outcomes.
• The inclusion of ipsilateral POD_ICA-CV in the predictive model significantly enhanced its ability to predict functional outcomes (0.893 vs. 0.842, p = 0.027).

Conclusions:

• Ipsilateral POD_ICA-CV serves as a valuable indicator of cerebral reperfusion status following thrombectomy.
• This POD_ICA-CV measurement effectively predicts functional outcomes in patients treated for acute ischemic stroke.
• The POD_ICA-CV offers an additional metric for assessing reperfusion efficacy and guiding patient management after endovascular therapy.