title: Delay of late-venous phase cortical vein filling in acute ischemic stroke patients: Associations with collateral status.
abstract: Evaluation of the venous system may be useful in stroke prognostication and patient selection for acute intervention strategies. We report a novel phenomenon, delayed-late venous phase cortical vein filling, observed on dynamic computed tomography angiography obtained using multidetector computed tomography scanner, in acute ischemic stroke patients. The aim of this study was to examine the frequency of delayed-late venous phase cortical vein filling and assess its association to baseline collateral status. Dynamic computed tomography angiography images of acute ischemic stroke patients, being assessed for reperfusion therapy, were prospectively studied. Delayed-late venous phase cortical vein filling was defined by late venous phase opacification of cortical veins despite contrast clearance from contralateral cortical veins on dynamic computed tomography angiography. Time to peak of maximum arterial enhancement was recorded. A total of 117 patients (mean age = 70.6 ± 13.3 years; males = 48%) with hemispheric ischemic stroke who underwent acute dynamic computed tomography angiography were included in the study. Overall, 56 (48%) demonstrated delayed-late venous phase cortical vein filling. Poor collateralization (OR = 13.50; 95% CI = (4.2, 43); p ≤ 0.0001) and longer time to peak of maximum arterial enhancement (OR = 3.2; 95% CI = (1.96, 5.3); p  ≤ 0.0001) were positively associated with delayed-late venous phase cortical vein filling. Delayed-late venous phase cortical vein filling was independently associated with poor baseline collateral status (75% vs. 15%, p ≤ 0.0001; OR = 14.38; 95% CI = (4.33, 47.8); p ≤ 0.0001). Delayed-late venous phase cortical vein filling is frequently seen in patients with acute ischemic stroke and is associated with poor baseline collateralization.
authors.affiliation: 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.|2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
authors.forename: Sonu
authors.initials: S
authors.lastname: Bhaskar
authors.affiliation: 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bivard
authors.affiliation: 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.|2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.affiliation: 2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia.|3 Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: 4 Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
authors.forename: John R
authors.initials: JR
authors.lastname: Attia
authors.affiliation: 2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Stanwell
authors.affiliation: 1 Department of Neurology, John Hunter Hospital, University of Newcastle, NSW, Australia.|2 Centre for Translational Neuroscience and Mental Health, School of Health Sciences and Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014680:Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: CTA; Stroke; angiography; collateral flow; venous flow