title: Ipsilateral Prominent Thalamostriate Vein on Susceptibility-Weighted Imaging Predicts Poor Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke.
abstract: OBJECTIVE
  The impact of deep cerebral veins on neurologic outcome after intravenous thrombolysis in patients with acute ischemic stroke is unclear. We investigated the relationship between the appearance of deep cerebral veins on susceptibility-weighted imaging and neurologic outcome in patients who underwent thrombolysis.
  
  
  METHODS
  We retrospectively analyzed 109 consecutive patients with acute ischemic stroke who had pretreatment SWI and received intravenous thrombolysis within 6 hours. We calculated the signal difference ratio (defined as the relative difference in signal intensity between the ipsilateral and contralateral veins) of the thalamostriate vein, septal vein, and internal cerebral vein on pretreatment SWI.
  
  
  RESULTS
  Only the signal difference ratio of the thalamostriate vein was significantly associated with poor outcome (3-month modified Rankin Scale score > 2,P= .008). The optimal threshold was relative hypointensity of the ipsilateral vein of >4.8% (sensitivity of 53.7% and specificity of 80.9%). We defined a signal difference ratio of the thalamostriate vein of ≥5% as an ipsilateral prominent thalamostriate vein. Patients with an ipsilateral prominent thalamostriate vein were more likely to have poor outcome (OR = 3.66; 95% CI, 1.25-10.68;P= .02) and a lower rate of successful reperfusion (reperfusion rate of ≥70%; OR = 0.35; 95% CI, 0.13-0.92;P= .03), compared with those without an ipsilateral prominent thalamostriate vein. However, patients with an ipsilateral prominent thalamostriate vein were still less likely to experience poor outcome when reperfusion was achieved compared with when reperfusion did not occur (80.0% versus 44.4%,P= .04).
  
  
  CONCLUSIONS
  A pretreatment ipsilateral prominent thalamostriate vein was associated with reduced reperfusion after thrombolysis and poor outcome. More intensive reperfusion approaches may be required for patients with an ipsilateral prominent thalamostriate vein.
authors.affiliation: From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.).
authors.forename: X
authors.identifier: http://orcid.org/0000-0002-6393-6725
authors.initials: X
authors.lastname: Zhang
authors.affiliation: From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.).
authors.forename: S
authors.identifier: http://orcid.org/0000-0003-0644-7930
authors.initials: S
authors.lastname: Zhang
authors.affiliation: From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.).
authors.forename: Q
authors.identifier: http://orcid.org/0000-0002-5702-0331
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Radiology (W.D.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors.forename: W
authors.identifier: http://orcid.org/0000-0001-8082-4154
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of Neurology (B.C.V.C.), Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia.
authors.forename: B C V
authors.identifier: http://orcid.org/0000-0003-3632-9433
authors.initials: BCV
authors.lastname: Campbell
authors.affiliation: From the Departments of Neurology (X.Z., S.Z., Q.C., M.L.) loumingxc@vip.sina.com.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-6627-064X
authors.initials: M
authors.lastname: Lou
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy / Q000473:pathology; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome