Presenter of 1 Presentation
POOR CORTICAL VENOUS OPACIFICATION ON BASELINE CTA PREDICTS POST-EVT PARENCHYMAL HEMORRHAGE AND WORSE OUTCOMES
Abstract
Background and Aims
Parenchymal hemorrhage (PH) is a major complication in patients with acute ischemic stroke. We studied the association between cortical venous opacification and risk of PH following endovascular treatment (EVT).
Methods
This is a post hoc analysis of patients in the control arm of ESCAPE NA-1 trial who had adequate venous assessment on CT angiography. Any PH and symptomatic intracranial hemorrhage (SICH) were compared between patients with poor venous opacification (cortical vein opacification score (COVES) <3) versus good opacification (COVESā„3). The relationships with unfavorable functional outcome (90d modified Rankin scale 3-6) and mortality were assessed.
Results
Among 545 patients, 55 (10.2%) had PH (6.7% PH1 and 3.5% PH2) and 19 (3.5%) had SICH. Poor venous opacification was observed in 286 patients (51.4% women, median age 71 years, interquartile range 61-81). Poor venous opacification was independently associated with PH in univariable and multivariable logistic regression adjusted for age, NIHSS score, ASPECTS, occlusion site, alteplase, collateral status, and time from onset to randomization, 43/283 (15.2%) in poor venous opacification vs. 12/257 (4.7%) in good opacification group (adjusted OR 3.2 [95% CI, 1.6-6.6]). SICH was not associated with venous opacification, 14/283 (4.9%) vs. 5/257 (1.9%), p=0.06 (unadjusted OR 2.6 [95% CI, 0.9-7.4]) in poor and good opacification groups, respectively. Poor opacification predicted unfavorable functional outcome (adjusted OR 3.4, 95% CI, 2.2-5.4) and mortality (adjusted OR 2.2, 95% CI, 1.2-4.0).
Conclusions
Poor venous opacification on CTA is strongly associated with an increased risk of parenchymal hemorrhage and worse clinical outcomes after EVT.