Article Figures & Data
Figures
- Fig 1.
MR imaging showing MCA and ICA-MCA occlusions with SVS (black arrow). A and B, TOF and T2* sequences show occlusion of the left MCA. C and D, TOF and T2* sequences show occlusion of the left ICA-MCA.
- Fig 2.
Three-month mRS after MT in patients with SVS (n = 53) and in patients without SVS (n = 20). Brackets indicate the percentage of patients achieving a good mRS score of 0–2; mRS scores of 3, 4–5, and 6 represent intermediate neurologic outcome, poor neurologic outcome, and death, respectively.
- Fig 3.
A 52-year-old patient with an initial NIHSS score of 19. At day 1, the NIHSS score was 17 without recovery on the following days. There was no spontaneous hyperattenuation on CT at day 1. At 3 months, mRS was 4. A, DWI shows restriction of diffusion with an initial ASPECTS of 7 (white arrowhead). B, GRE T2* shows a right SVS− occlusion (black arrowhead). C, Pretreatment DSA shows right MCA occlusion (thin black arrow); the time between onset and groin puncture was 270 minutes. D, Post-MT DSA shows successful recanalization (TICI 3).
- Fig 4.
A 48-year-old patient with an initial NIHSS score of 21 and a 3-month mRS of 1. A, DWI shows restriction of diffusion with an initial ASPECTS of 6 (white arrowhead). B, GRE T2* shows a right SVS+ occlusion (black arrowhead). C, Pretreatment DSA shows a right MCA occlusion (thin black arrow); the time between onset and groin puncture was 240 minutes. D, Post-MT DSA shows successful recanalization (TICI 3).
Tables
- Table 1:
Patient characteristics and MRI findings before MT and complications and clinical outcome after MT in patients with and without SVS
SVS− (n = 20) SVS+ (n = 53) P Value Before thrombectomy Age (yr) (mean) 59 ± 12 59 ± 14 .93 Sex ratio Female 10 (50%) 27 (51%) .94 Male 10 (50%) 26 (49%) Cardiovascular risk factors Hypertension 9 (45%) 18 (35%) .42 Diabetes 2 (10%) 4 (8%) .67 Hyperlipidemia 8 (40%) 14 (27%) .28 Smoking 7 (35%) 9 (17%) .12 Obesity 1 (5%) 7 (13%) .43 Initial NIHSS .66 ≤10 1 (5%) 6 (11%) 10–20 11 (55%) 27 (51%) >20 8 (40%) 20 (38%) ASPECTS .68 ≤7 8 (40%) 24 (45%) >7 12 (60%) 29 (55%) Side of occlusion .45 Left 14 (70%) 32 (60%) Right 6 (30%) 21 (40%) Site of occlusion .37 ICA 9 (45%) 30 (57%) MCA 11 (55%) 23 (43%) Dissection 1 (5%) 10 (19%) .27 IV tPA 11 (55%) 29 (55%) .98 Onset-to-groin puncture ≤270 min 5 (25%) 13 (25%) .98 270 min to 360 min 8 (40%) 20 (38%) >360 min 7 (35%) 20 (38%) After thrombectomy TICI ≥2b–3 14 (70%) 43 (81%) .34 Lack of spontaneous hyperattenuation on CT 11 (55%) 31 (58%) .79 NIHSS at day 1 .03 ≤10 6 (30%) 29 (55%) 10–20 9 (45%) 21 (40%) >20 5 (25%) 3 (6%) mRS ≤2 5 (26%) 33 (65%) .004 - Table 2:
Patient characteristics, MRI findings before MT, complications, and clinical outcome after MT in patients with good (mRS ≤2) and bad (mRS ≥2) outcomes
mRS ≤2 (n = 38) mRS >2 (n = 32) P Value Before thrombectomy Age (mean) 58 ± 13 61 ± 13 .25 Sex ratio Female 21 (55%) 15 (47%) .43 Male 17 (45%) 17 (53%) Cardiovascular risk factors Hypertension 12 (32%) 15 (48%) .16 Diabetes 2 (5%) 4 (13%) .40 Hyperlipidemia 13 (34%) 8 (26%) .45 Smoking 6 (16%) 8 (26%) .37 Obesity 4 (11%) 3 (10%) .61 Initial NIHSS ≤10 7 (18%) 0 (0%) .01 10–20 21 (55%) 16 (50%) >20 10 (26%) 16 (50%) ASPECTS .54 ≤7 16 (42%) 14 (44%) >7 22 (58%) 18 (56%) Side of occlusion Left 24 (63%) 19 (59%) .75 Right 14 (37%) 13 (41%) Site of occlusion .24 ICA 17 (45%) 19 (59%) MCA 21 (55%) 13 (41%) Dissection 5 (13%) 5 (16%) .52 SVS+ 33 (87%) 18 (56%) .004 IV tPA 22 (58%) 17 (53%) .81 Onset-to-groin puncture .59 ≤270 min 10 (26%) 7 (22%) 270 min to 360 min 16 (42%) 11 (34%) >360 min 12 (32%) 14 (44%) After thrombectomy TICI ≥2b–3 34 (89%) 20 (63%) .01 Lack of spontaneous hyperattenuation on CT 27 (71%) 13 (41%) .03 NIHSS at day 1 <.001 ≤10 31 (82%) 3 (9%) 10–20 7 (18%) 22 (69%) >20 0 (0%) 7 (22%) - Table 3:
Univariate and multivariate logistic regression analyses for factors associated with mRS ≤2
Univariate Multivariate OR 95% CI P Value OR 95% CI P Value Age 0.9 0.9–1.01 .25 0.9 0.9–1.01 .13 Sex 1.4 0.5–3.6 .48 Initial NIHSS (≤20 vs >20) 0.8 0.3–2.1 .66 ASPECTS (≤7 vs >7) 0.9 0.4–2.4 .89 Dissection 1.2 0.3–4.7 .77 ICA occlusion 1.8 0.7–4.7 .22 IV tPA 0.8 0.3–2.1 .69 Onset-to-groin puncture .58 270 min to 6 hr vs >360 min 1.7 0.6–5.0 ≤270 min vs >360 min 1.7 0.5–5.7 SVS+ 5 1.6–16.6 .01a 8.7 1.1–69.4 .04a Lack of spontaneous hyperattenuation on CT 3.6 1.3–9.7 .01a 3.6 0.7–18.9 013 Day 1 NIHSS (≤10 vs >10) 51.5 11.8–225.1 <.001a 51.9 8.4–320.5 <.001a TICI (≥2b vs <2b) 5.1 1.4–17.9 .01a 7.1 0.4–112.8 .16 ↵a Significant.
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