The Cortical Vein Opacification Score (COVES) is independently associated with good and excellent functional outcomes at 90-days in minor stroke patients with anterior circulation large vessel occlusion: A Multicenter Study.

Dhairya A Lakhani, Hamza Salim, Aneri B Balar, Subtain Ali, Sijin Wen, Janet Mei, Argye E Hillis, Victor C Urrutia, Risheng Xu, Gabriel Broocks, Jens Fiehler, Helge C Kniep, Paul Stracke, Hermann Krähling, Gregory W Albers, Maarten Lansberg, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Vivek S Yedavalli
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Abstract

Background: There is currently no consensus on the most appropriate emergent treatment for patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO) and minor stroke. These patients were excluded from prior randomized controlled trials assessing the efficacy of mechanical thrombectomy (MT) in LVO, making it challenging to determine the best treatment approach. Therefore, identifying markers that can predict functional outcomes would be invaluable for triaging these patients for MT. This study aimed to investigate pretreatment clinical and imaging markers and their association with functional outcomes at 90 days in minor AIS- LVO patients.

Methods: We included patients with AIS-LVO and minor strokes from four sites across North America and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤5. The primary outcome measure, good functional outcome, was defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcome, excellent functional outcome, was defined as an mRS score of 0-1 at 90 days. Univariable and multivariable logistic regression analyses, along with receiver operating characteristic (ROC) curve analysis, were performed.

Results: Among 168 consecutive patients with minor strokes, 123 achieved a good functional outcome, and 103 patients had an excellent functional outcome at 90 days. The cortical vein opacification score (COVES) was independently associated with both excellent and good functional outcomes, whereas no other CT, CTA, or CTP markers showed a significant association with these outcomes. ROC analysis of COVES showed an area under the curve (AUC) of 0.638 (95% CI: 0.517-0.759, p = 0.026) for predicting a good functional outcome and 0.689 (95% CI: 0.537-0.741, p = 0.008) for predicting an excellent functional outcome. Similar results were observed in the subgroup of patients who underwent mechanical thrombectomy (MT). Interestingly, neither intravenous thrombolysis (IVT) nor mechanical thrombectomy (MT) was associated with functional outcomes.

Conclusions: Our analysis demonstrates that COVES is independently associated with good and excellent functional outcomes at 90 days in minor AIS-LVO cases. Further prospective studies are needed to better understand the role of COVES in determining optimal management strategies for these patients.

Abbreviations: CS: Collateral status; COVES: Cortical vein opacification score; MT: mechanical thrombectomy; IVT: intravenous thrombolysis; NIHSS: National Institutes of Health Stroke Scale.

皮质静脉混浊评分(COVES)与轻度卒中前循环大血管闭塞患者90天的良好和优异功能预后独立相关:一项多中心研究。
背景:对于继发于大血管闭塞(AIS-LVO)和轻微中风的急性缺血性卒中患者的最合适的紧急治疗方法,目前还没有达成共识。这些患者被排除在先前评估LVO机械取栓(MT)疗效的随机对照试验之外,这使得确定最佳治疗方法具有挑战性。因此,识别能够预测功能结局的标志物对于鉴别这些患者是否患有MT非常重要。本研究旨在研究预处理临床和影像学标志物及其与轻度AIS- LVO患者90天功能结局的关系。方法:我们纳入了来自北美和欧洲四个地区的AIS-LVO和轻微卒中患者。轻度脑卒中定义为基线美国国立卫生研究院脑卒中量表(NIHSS)评分≤5分。主要结局指标,良好的功能结局,定义为90天时修改的Rankin量表(mRS)评分0-2分。次要结局,良好的功能结局,定义为90天mRS评分0-1。单变量和多变量logistic回归分析以及受试者工作特征(ROC)曲线分析。结果:在168例连续轻度卒中患者中,123例患者在90天功能预后良好,103例患者功能预后良好。皮质静脉混浊评分(COVES)与优秀和良好的功能预后均独立相关,而其他CT、CTA或CTP标记与这些预后均无显著相关性。COVES的ROC分析显示,预测良好功能预后的曲线下面积(AUC)为0.638 (95% CI: 0.517-0.759, p = 0.026),预测良好功能预后的曲线下面积(AUC)为0.689 (95% CI: 0.537-0.741, p = 0.008)。在接受机械取栓(MT)的亚组患者中也观察到类似的结果。有趣的是,静脉溶栓(IVT)和机械取栓(MT)都与功能预后无关。结论:我们的分析表明,在轻度AIS-LVO病例中,COVES与90天的良好和优异的功能预后独立相关。需要进一步的前瞻性研究来更好地了解COVES在确定这些患者的最佳管理策略中的作用。缩写词:CS:抵押品状态;COVES:皮质静脉混浊评分;MT:机械取栓;IVT:静脉溶栓;NIHSS:美国国立卫生研究院卒中量表。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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