Venous opacification could be a novel biomarker for the success of intra-arterial therapy (IAT), an endovascular approach to functional recovery in stroke patients, research published in Radiology this month suggests.
University of Amsterdam radiologist Ivo G.H. Jansen, MD, and colleagues said decisions about IAT, which is beneficial to most acute ischemic stroke patients but detrimental to a select few, have historically been based on factors like cerebral collateral flow, but no one characteristic has been defined as the make-or-break for success of the therapy.
“So if you want to exclude someone from this treatment because you do not expect him or her to benefit, you want to be really certain,” Jansen told the Radiological Society of North America. “This means that research on these patient characteristics must be fairly robust before we can reliably tell someone, or someone’s family, that we will not be able to use IAT.”
Jansen and his team focused on the venous system for their research, since prior studies had overlooked the region. The researchers honed in on just three veins using CT angiography—the superficial middle cerebral vein, the vein of Labbe and the sphenoparietal sinus–and found their answer. The idea, Jansen told the Radiological Society of North America, was that if blood was passing through tissue, that tissue had to be functioning in some way, indicating less damage to the patient.
“We looked at each of the three veins individually,” he said. “We looked at their opacification compared to the contralateral hemisphere and assessed whether there was no, moderate or full opacification of the vein.”
Neurologists graded each vein, data for which was pulled from the Netherlands’ MR CLEAN database, on a scale from 0 to 2. The top of the scale represented full opacification, according to the research.
Jansen et al. found that patients with a cortical vein opacification score of 0, meaning no opacification in the veins, meant that individual was less likely to achieve functional outcome after IAT. Those with scores of 2, they said, saw a much larger shift toward functional outcome.
The researchers also found that patients with scores of 0 had higher mortality rates at seven and 30 days than those with higher scores. Jansen said the results were “clear-cut” and what the team expected, and that more research is warranted to confirm the findings. Still, he said, the novel scoring system can contribute to the pool of ways clinicians discern whether IAT is right for a particular patient.
“I think a combination of factors is the way to go here,” Jansen said. “Maybe a combination of a collateral grade with a COVES score can add to the prognostic value of both parameters and give a more complete picture of what is going on with cerebral vasculature during a stroke.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.