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Clinical implications of cerebral venous outflow pattern in malignant middle cerebral artery infarction
1Department of Neurology, Gimcheon Jeil Hospital, Gimcheon, South Korea.
Background:
Malignant middle cerebral artery (MCA) infarction is one of the most devastating strokes. However, the role of the cerebral venous outflow pattern in malignant MCA infarction is not well established. We investigated the association between the transverse sinus (TS) shape and functional outcomes in patients with malignant MCA infarction.
Methods:
This retrospective cohort study included patients with malignant MCA infarction. Baseline characteristics, clinical variables, and cerebral venous outflow patterns (TS shape) were obtained. Incomplete TS shapes are referred to as unilateral TS hypoplasia, TS aplasia, or TS occlusion. We analyzed the effect of an incomplete TS shape on functional outcomes after malignant MCA infarction. The main outcome assessed was the change in ordinal shifts within the modified Rankin Scale score, indicating a deterioration in the outcome at three months.
Results:
Among 71 patients with malignant MCA infarction, incomplete TS shapes were observed in 33 (46.5 %). There were no significant differences in the baseline characteristics, vascular risk factors, or factors associated with malignant MCA infarction. Patients with incomplete TS shapes had a higher proportion of unfavorable functional outcomes (5.0 [4.0-5.0] vs. 5.0 [5.0-6.0], P < 0.001). Multivariable ordinal logistic regression analysis showed that patients with incomplete TS shapes (odds ratio = 6.30, 95 % confidence interval = 2.42-17.90, P < 0.001) had a substantial shift towards the unfavorable functional outcome at 3 months.
Conclusions:
Among patients diagnosed with malignant MCA infarction, those with incomplete TS shapes had poorer functional outcomes and higher mortality rates. This underscores the significant clinical association between cerebrovenous patterns and functional outcomes.
Insights
Incomplete transverse sinus shapes are linked to worse outcomes in malignant middle cerebral artery (MCA) infarction. This finding highlights the importance of cerebral venous patterns in stroke recovery.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Malignant middle cerebral artery (MCA) infarction is a severe stroke type.
- The influence of cerebral venous outflow patterns on malignant MCA infarction outcomes is not fully understood.
- Investigating the transverse sinus (TS) shape's association with functional outcomes in these patients is crucial.
Purpose of the Study:
- To determine the relationship between transverse sinus (TS) shape and functional outcomes in patients with malignant MCA infarction.
- To assess if incomplete TS shapes predict poorer functional outcomes.
Main Methods:
- Retrospective cohort study of patients with malignant MCA infarction.
- Evaluation of cerebral venous outflow patterns, specifically transverse sinus (TS) shape (including hypoplasia, aplasia, or occlusion).
- Analysis of functional outcomes using the modified Rankin Scale at three months.
Main Results:
- Nearly half (46.5%) of the 71 patients had incomplete TS shapes.
- Patients with incomplete TS shapes showed a significantly higher proportion of unfavorable functional outcomes (P < 0.001).
- Incomplete TS shapes were independently associated with a substantial shift towards unfavorable outcomes (OR=6.30, P < 0.001).
Conclusions:
- Incomplete transverse sinus (TS) shapes are associated with poorer functional outcomes and higher mortality in malignant MCA infarction.
- Cerebrovenous patterns, particularly TS morphology, play a significant role in the clinical course and prognosis of malignant MCA infarction.
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