Internal cerebral vein asymmetry on follow-up brain computed tomography after intravenous thrombolysis in acute anterior circulation ischemic stroke is associated with poor outcome

Vijay K Sharma; Leonard L L Yeo; Hock L Teoh; Liang Shen; Bernard P L Chan; Raymond C Seet; Aftab Ahmad; Vincent F Chong; Prakash R Paliwal

doi:10.1016/j.jstrokecerebrovasdis.2013.08.007

Internal cerebral vein asymmetry on follow-up brain computed tomography after intravenous thrombolysis in acute anterior circulation ischemic stroke is associated with poor outcome

J Stroke Cerebrovasc Dis. 2014 Jan;23(1):e39-45. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.007. Epub 2013 Oct 8.

Authors

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

Affiliations

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: [email protected].
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.

PMID: 24119628
DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.007

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.

Keywords: Acute ischemic stroke; CT angiography; internal cerebral vein; thrombolysis.

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Brain / diagnostic imaging*
Brain Ischemia / classification
Brain Ischemia / diagnostic imaging*
Cerebral Veins / diagnostic imaging*
Cerebral Veins / pathology
Cerebrovascular Circulation / physiology*
Cohort Studies
Female
Fibrinolytic Agents / therapeutic use
Humans
Male
Middle Aged
Registries
Retrospective Studies
Risk Factors
Sex Factors
Stroke / classification
Stroke / diagnostic imaging*
Thrombolytic Therapy*
Tissue Plasminogen Activator / therapeutic use
Tomography, X-Ray Computed
Treatment Outcome
Young Adult

Substances

Fibrinolytic Agents
Tissue Plasminogen Activator