Sigmoid Sinus Characteristics Correlate with Early Clinical and Imaging Surrogates in Anterior Circulation Ischemic Stroke

Slaven Pikija,Nele Bubel,Jozef Magdic,Johann Sellner,David S Liebeskind,Arthur Karamyan,Mark R Mccoy

doi:10.1007/s12035-016-0091-0

Abstract

Cerebral venous outflow may play a decisive role in acute ischemic stroke. Here, we assessed the relation of cerebral sinus vein characteristics with clinical and imaging surrogates of early outcome in acute ischemic stroke. We evaluated cerebral vein characteristics in 212 patients with the middle cerebral artery (MCA) occlusive stroke confirmed by CT angiography CTA within 6 h from symptom onset. Readout parameters included volume and density of the sigmoid sinus (SS) and density of the superior sagittal sinus (SupSagS). These were correlated with early clinical outcome defined as hospital death (HD), final infarct volume (FIV), and National Institute of Health Stroke Scale (NIHSS) at discharge. We found a correlation for the volume of the right SS and the FIV when the M1 segment of the MCA of either side was occluded (p = 0.002, Rho = 0.206, n = 134). A decrease in SS density was more pronounced in the subgroup with unfavorable outcome (NIHSS > 15 + HD) but only when the left hemisphere was affected (p = 0.026, n = 101). On stepwise logistic regression analysis, adjusted for on-admission NIHSS, age at presentation, and FIV, smaller SS volume was independently associated with lower odds for hospital death (n = 183, OR 0.13, 95 % CI 0.02–0.94, p = 0.043). A larger right SS and a decrease in density increase the risk of unfavorable early clinical and imaging outcome in AIS. This finding of an outflow pattern independent of the stroke site implicates an involvement of the cerebral venous drainage system in the pathophysiology of ischemic stroke.

Highlights

Recent advances in vascular neuroimaging in patients with acute ischemic stroke (AIS) have led to the identification of prognostic factors
We found a trend for the correlation of the density of the right SS and unfavorable outcome in the ipsilateral middle cerebral artery (MCA) M1 occlusion (p = 0.051)
Our study disclosed that a larger right SS in terms of pronounced asymmetry is associated with hospital death and the larger final infarct volume in the setting of MCA M1 occlusion of either side

Summary

Introduction

Recent advances in vascular neuroimaging in patients with acute ischemic stroke (AIS) have led to the identification of prognostic factors. There is emerging evidence that good collateral circulation during AIS is associated with favorable clinical outcome, lesser extent of infarct volume, and success of revascularization measures [3,4,5,6]. Since the majority of the cerebral blood volume in the brain is contained in the venous pool, a restricted outflow may be of prognostic relevance. A recent study suggested that limitation of the ipsilateral venous drainage could contribute to development of edema in the setting of malignant middle cerebral artery (MCA) infarction [7]. Cortical venous drainage may play a prognostic role for clinical outcome [8]

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Results

Conclusion