Abstract
BackgroundSusceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO).MethodsOne hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as an increase in the National Institutes of Health Stroke Scale score ≧2 points despite standard treatment in the first 72 h after admission. The APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI.ResultsThirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P = 0.001). Patients with APCVS were more likely to have END (40.0%, vs. 12.2%, P = 0.001) than those without END. Multivariate logistic regression indicated that APCVS (OR = 4.349, 95% C.I. = 1.580–11.970, P = 0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume.ConclusionsIn acute ischemic stroke patients with SIASO, the APCVS might be a useful neuroimaging marker for predicting END, which suggests the importance of evaluation of perfusion status.
Highlights
Susceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin
Patients with acute ischemic stroke (AIS) caused by intracranial atherosclerosis stenosis or occlusion have a higher risk of early neurological deterioration (END), and the possible underlying mechanisms include hemodynamics, hypoperfusion, or thrombus extension [4,5,6,7]
In most cases, the asymmetrical prominent cortical vein sign (APCVS) occurs in patients with severe intracranial arterial stenosis or occlusion (SIASO), which indicates that SIASO should be considered in the analysis of AIS patients
Summary
Susceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO). Patients with AIS caused by intracranial atherosclerosis stenosis or occlusion have a higher risk of early neurological deterioration (END), and the possible underlying mechanisms include hemodynamics, hypoperfusion, or thrombus extension [4,5,6,7]. In most cases, the APCVS occurs in patients with severe intracranial arterial stenosis or occlusion (SIASO), which indicates that SIASO should be considered in the analysis of AIS patients It is unknown whether an APCVS increases the risk of END in AIS patients with SIASO.
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