Cortical venous opacification score predicts outcomes after thrombectomy in large vessel occlusion stroke: a systematic review and meta-analysis.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-09-01 Epub Date: 2025-07-30 DOI:10.1007/s00234-025-03701-2

Rafaela Correia Maciel, Wei Jun Lee, Beatriz Aguiar de Macedo, Davi Barbosa Pereira da Silva, Amanda Boutrik, Maria Clara Merighi, Henrique Alexsander Ferreira Neves, Luisa Braga Salles Machado, Bernard Giancristoforo Campos

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引用次数: 0

Abstract

Purpose: This study aimed to assess whether the Cortical Vein Opacification Score (COVES), a visual scoring system based on single-phase Computed Tomography Angiography (CTA), is associated with clinical and radiological outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT).

Methods and materials: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, EMBASE, and Cochrane Library were searched from inception to early June 2025, identifying 572 articles, of which 6 were included. Post-hoc analyses of randomized controlled trials (RCTs) and observational studies, with patients stratified by venous outflow (VO) status, were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using I² statistic. Sensitivity analyses were performed in outcomes that presented high heterogeneity.

Results: The six studies included 2,709 patients. VO + was associated with higher excellent (RR 1.34; p < 0.001) and successful reperfusion (RR 1.05; p = 0.001). Functional independence at 90 days (modified Rankin Scale [mRS] 0-2) was higher in the VO + group (RR 2.67; p = 0.002). VO + was associated with lower rates of symptomatic intracranial hemorrhage (sICH), parenchymal hematoma (PH), and mortality at 90 days.

Conclusion: VO + is associated with better reperfusion and functional independence, as well as reduced hemorrhagic complications and mortality. These findings support the potential prognostic value of VO in AIS-LVO patients undergoing EVT. Heterogeneity and limited number of studies warrant cautious interpretation. Standardized imaging protocols and prospective validation are needed.

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皮质静脉混浊评分预测大血管闭塞中风取栓后的预后：一项系统回顾和荟萃分析。

目的：本研究旨在评估皮质静脉混浊评分（COVES），一种基于单相计算机断层血管造影（CTA）的视觉评分系统，是否与血管内治疗（EVT）后大血管闭塞（AIS-LVO）急性缺血性卒中患者的临床和影像学结果相关。方法和材料：根据PRISMA指南进行系统评价和荟萃分析。检索了PubMed、EMBASE和Cochrane图书馆从成立到2025年6月初的572篇文章，其中6篇被纳入。纳入随机对照试验（rct）和观察性研究的事后分析，患者按静脉流出（VO）状态分层。采用随机效应模型计算合并风险比（rr）和95%置信区间（ci）。采用I²统计量评估异质性。对异质性较高的结果进行敏感性分析。结果：6项研究共纳入2709例患者。VO +与较高的优良率相关(RR 1.34；结论：VO +与更好的再灌注和功能独立性，以及减少出血并发症和死亡率有关。这些发现支持VO对接受EVT的AIS-LVO患者的潜在预后价值。异质性和有限的研究数量需要谨慎的解释。标准化的成像方案和前瞻性验证是必要的。

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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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.