Comprehensive venous outflow is the optimal venous score in predicting functional outcome in acute ischemic stroke patients

BACKGROUND: Venous outflow (VO) is a promising prognostic imaging biomarker in acute ischemic stroke (AIS) patients selected for endovascular treatment (EVT). However, the best score for properly assessing VO profiles on multi-phase CT-Angiography (mCTA) remains to be identified. METHODS: A series of consecutive AIS patients undergoing EVT for large vessel occlusion within 24 h from symptom onset were investigated. The following scores were rated: cortical vein score difference in stroke (PRECISE, range 0-8), cortical vein opacification score (COVES, range 0-6), comprehensive venous outflow (CVO, range 0-8) and internal cerebral vein (ICV) asymmetry. Receiver operating characteristic curves and multivariable logistic regression analyses were performed to explore the performance of the different VO scores for prediction of a good outcome (modified Rankin Scale 0-2 at 3 months). RESULTS: Three hundred and thirty-six subjects (56.2% females, mean age 74.8) were included, of whom 145 (43.1%) had good outcomes. In multivariable logistic analysis, the CVO score (odds ratio = 2.51, 95% CI = 1.49-4.18, p = .001) was the only independent predictor of good functional outcomes. The AUC of the CVO score was .75 (95% CI = .70-.80), with an optimal cut-off of ≥4 (sensitivity 56%, specificity 69%). Patients with favourable CVO profiles had better pial arterial (70.7%, p < .001) and hypoperfusion intensity ratio (HIR) tissue-related collaterals (HIR = .35, p = .005), higher rates of successful recanalization (95.7%, p < .001) and lower symptomatic intracranial haemorrhage occurrence (6%, p = .020) than those with unfavourable CVO profiles. CONCLUSION: The CVO score measured on mCTA had the best discriminative performance and was independently associated with functional outcome in AIS patients undergoing EVT within 24 h from onset.