Deans' stroke musings: Favorable Venous Outflow Linked to Reperfusion Success After Thrombectomy

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, July 1, 2021

Favorable Venous Outflow Linked to Reperfusion Success After Thrombectomy

I'm 100% positive your definition of success doesn't correspond to any survivors. I'm sure you're using the tyranny of low expectations to claim success when none exists.

Favorable Venous Outflow Linked to Reperfusion Success After Thrombectomy

A favorable venous outflow (VO), determined by the cortical vein opacification score (COVES), is associated with reperfusion success and good functional outcomes in patients who undergo endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion (AIS-LVO), according to study findings published in Neurology.

This retrospective study included 565 consecutive patients with AIS-LVO who were treated by endovascular thrombectomy at 2 comprehensive stroke centers in Germany and the United States. Study investigators used baseline CTA to evaluate collateral status (Tan scale) and VO with the COVES. They defined a favorable VR by a COVES between 3 and 6, and an unfavorable one by a COVES between 0 and 2.

The primary study outcome was excellent reperfusion status (defined by the modified Thrombolysis on Cerebral Infarction 2c/3), while the secondary outcome was good functional outcomes 90 days post-treatment.

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Patients with favorable VO (VO+) were significantly younger (median, 72 years vs 76.5 years, respectively; P <.001), more likely to have received intravenous tPA (70% vs 40.9%, respectively; P <.001), and had less severe symptoms at presentation (P <.001) compared with patients with unfavorable VO.

Excellent vessel reperfusion during thrombectomy was associated with favorable VO in a multivariable logistic regression analysis (odds ratio [OR], 2.10; 95% CI, 1.39-3.16; P <.001).

A secondary outcome multivariable binary logistic regression analysis found independent associations between favorable clinical outcomes and both favorable VO+ profiles (OR, 8.9; 95% CI, 5.3-14.9; P <.001) and excellent post-thrombectomy vessel reperfusion status (OR, 2.7; 95% CI, 1.7-4.4; P <.001).

Limitations of this study included its retrospective design as well as the inclusion of only patients from 2 comprehensive stroke centers, which may limit the generalizability of the findings.

The study investigators concluded that the assessment of the venous microvascular system, among other alternative blood flow pathways, could “be an additional useful vascular biomarker associated with endovascular treatment success and good functional outcomes” in patients with AIS-LVO.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.