不同期相CTA脑静脉引流对急性缺血性卒中患者血管内治疗后短期预后的预测价值

doi:10.3969/j.issn.1673-5765.2026.01.008

摘要/Abstract

摘要： 目的探讨基于不同期相CTA的脑静脉引流（cerebral venous outflow，CVO）对急性缺血性卒中（acute ischemic stroke，AIS）患者血管内治疗（endovascular treatment，EVT）后短期预后的预测价值。
方法回顾性纳入2023年3月—2024年1月于南京医科大学第一附属医院就诊并接受EVT的AIS患者。根据EVT后90 d mRS评分将患者分为预后良好（mRS评分为0～2分）组和预后不良（mRS评分为3～6分）组。利用CTP原始数据重建三期（动脉峰期、静脉峰期和静脉晚期）CTA图像。采用脑皮质静脉显影评分（cortical vein opacification score，COVES）在不同期相CTA图像中分别评估CVO状态，优良CVO定义为COVES 3～6分，不良CVO定义为COVES 0～2分。采用Mann-Whitney U检验及卡方检验进行单因素分析，将差异有统计学意义的变量纳入多因素logistic回归分析，筛选AIS患者EVT后短期预后的独立影响因素。通过ROC曲线评估不同预测模型的预测效能。
结果共纳入82例AIS患者，预后良好组43例，预后不良组39例。与预后良好组相比，预后不良组的基线NIHSS评分更高，静脉峰期优良CVO比例更低，Alberta卒中项目早期CT评分（Alberta stroke program early CT score，ASPECTS）更低，基线核心梗死体积更大（均P<0.05）。多因素logistic回归分析显示，基线NIHSS评分（OR 1.134，95%CI 1.030～1.247，P=0.010）、静脉峰期优良CVO（OR 0.070，95%CI 0.020～0.245，P<0.001）及ASPECTS（OR 0.723，95%CI 0.539～0.971，P=0.031）是AIS患者EVT后短期预后的独立影响因素。ROC曲线分析表明，模型1（纳入基线NIHSS评分及ASPECTS）预测短期预后不良的AUC为0.773（95%CI 0.668～0.859），敏感度为66.7%，特异度为81.4%；模型2（纳入基线NIHSS评分、ASPECTS及静脉峰期优良CVO）的AUC为0.874（95%CI 0.782～0.937），敏感度为89.7%，特异度为72.1%。模型2的预测效能优于模型1（P=0.024）。
结论静脉峰期是CTA评估CVO的最佳期相，将静脉峰期优良CVO纳入预测模型可提高其对AIS患者EVT后短期预后的预测效能。

文章导读： 本研究提示，静脉峰期脑静脉引流对急性缺血性卒中患者血管内治疗后短期预后具有较好的预测价值，为临床治疗决策的制订提供了新的参考依据。

关键词: 急性缺血性卒中; 血管内治疗; 短期预后; 静脉引流

Abstract: Objective To explore the predictive value of cerebral venous outflow (CVO) based on multiphase CTA for short-term prognosis in patients with acute ischemic stroke (AIS) after endovascular treatment (EVT).
Methods Patients with AIS who underwent EVT at the First Affiliated Hospital with Nanjing Medical University from March 2023 to January 2024 were retrospectively enrolled. They were divided into a favorable prognosis group (mRS score 0-2) and a poor prognosis group (mRS score 3-6) based on the mRS score at 90 days after EVT. Three-phase (arterial peak phase, venous peak phase, and late venous phase) CTA images were reconstructed using original CTP data. CVO status was evaluated on each CTA phase using the cortical vein opacification score (COVES). Favorable CVO was defined as a COVES of 3-6 points, and poor CVO was defined as a COVES of 0-2 points. Univariate analyses were performed using the Mann-Whitney U test and χ2 test. Variables with statistically significant differences were included in multivariate logistic regression analysis to identify independent influencing factors for the short-term prognosis of AIS patients after EVT. Predictive efficacy of different models was assessed using ROC curves.
Results A total of 82 AIS patients were enrolled, including 43 patients in the favorable prognosis group and 39 patients in the poor prognosis group. Compared with the favorable prognosis group, the poor prognosis group had significantly higher baseline NIHSS scores, a lower proportion of favorable CVO in the venous peak phase, a lower Alberta stroke program early CT score (ASPECTS), and larger baseline core infarction volume (all P<0.05). Multivariate logistic regression analysis revealed that baseline NIHSS score (OR 1.134, 95%CI 1.030-1.247, P=0.010), favorable CVO in the venous peak phase (OR 0.070, 95%CI 0.020-0.245, P<0.001), and ASPECTS (OR 0.723, 95%CI 0.539-0.971, P=0.031) were independent influencing factors for short-term prognosis of AIS patients after EVT. ROC curve analysis showed that Model 1 (incorporating baseline NIHSS score and ASPECTS) had an AUC of 0.773 (95%CI 0.668-0.859) for predicting short-term poor prognosis, with a sensitivity of 66.7% and a specificity of 81.4%. Model 2 (incorporating baseline NIHSS score, ASPECTS, and favorable CVO in the venous peak phase) had an AUC of 0.874 (95%CI 0.782-0.937), with a sensitivity of 89.7% and a specificity of 72.1%. The predictive efficacy of Model 2 was significantly superior to that of Model 1 (P=0.024).
Conclusions Venous peak phase is the optimal phase for evaluating CVO by CTA. Incorporating favorable CVO in the venous peak phase into the prediction model can improve the predictive efficacy for short-term prognosis of AIS patients after EVT.

Key words: Acute ischemic stroke; Endovascular treatment; Short-term prognosis; Venous outflow

中图分类号:

殷子欣, 鲁珊珊, 施海彬, 吴飞云, 许晓泉. 不同期相CTA脑静脉引流对急性缺血性卒中患者血管内治疗后短期预后的预测价值[J]. 中国卒中杂志, 2026, 21(1): 70-77.

YIN Zixin, LU Shanshan, SHI Haibin, WU Feiyun, XU Xiaoquan. Predictive Value of Cerebral Venous Outflow on Multiphase CTA for Short-Term Prognosis in Patients with Acute Ischemic Stroke after Endovascular Treatment[J]. Chinese Journal of Stroke, 2026, 21(1): 70-77.

参考文献

[1] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022[J]. 中华神经科杂志，2022，55（6）：565-580.
Chinese Society of Neurology，Chinese Stroke Society，Neurovascular Intervention Group of Chinese Society of Neurology. Chinese guidelines for the endovascular treatment of acute ischemic stroke 2022[J]. Chin J Neurol，2022，55（6）：565-580.
[2] WOLLENWEBER F A，TIEDT S，ALEGIANI A，et al. Functional outcome following stroke thrombectomy in clinical practice[J]. Stroke，2019，50（9）：2500-2506.
[3] NGUYEN T N，ABDALKADER M，FISCHER U，et al. Endovascular management of acute stroke[J]. Lancet，2024，404（10459）：1265-1278.
[4] GOYAL M，MENON B K，VAN ZWAM W H，et al. Endovascular thrombectomy after large-vessel ischaemic stroke：a meta-analysis of individual patient data from five randomised trials[J]. Lancet，2016，387（10029）：1723-1731.
[5] ITO H，KANNO I，LIDA H，et al. Arterial fraction of cerebral blood volume in humans measured by positron emission tomography[J]. Ann Nucl Med，2001，15（2）：111-116.
[6] FAIZY T D，HEIT J J. Rethinking the collateral vasculature assessment in acute ischemic stroke：the comprehensive collateral cascade[J]. Top Magn Reson Imaging，2021，30（4）：181-186.
[7] FAIZY T D，KABIRI R，CHRISTENSEN S，et al. Distinct intra-arterial clot localization affects tissue-level collaterals and venous outflow profiles[J]. Eur J Neurol，2021，28（12）：4109-4116.
[8] FAIZY T D，KABIRI R，CHRISTENSEN S，et al. Association of venous outflow profiles and successful vessel reperfusion after thrombectomy[J/OL]. Neurology，2021，96（24）：e2903-e2911[2025-10-11]. https://doi.org/10.1212/WNL.0000000000012106.
[9] KELANI H，ABDELRAOUF M R，RATH S，et al. Prognostic value of cerebral venous outflow profiles for outcomes prediction following reperfusion therapy in acute ischemic stroke：a meta-analysis[J]. Neuroradiology，2025，67（9）：2283-2294.
[10] MENON B K，D’ESTERRE C D，QAZI E M，et al. Multiphase CT angiography：a new tool for the imaging triage of patients with acute ischemic stroke[J]. Radiology，2015，275（2）：510-520.
[11] BARBER P A，DEMCHUK A M，ZHANG J，et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy[J]. Lancet，2000，355（9216）：1670-1674.
[12] YEO L L L，PALIWAL P，TEOH H L，et al. Assessment of intracranial collaterals on CT angiography in anterior circulation acute ischemic stroke[J]. AJNR Am J Neuroradiol，2015，36（2）：289-294.
[13] FAIZY T D，KABIRI R，CHRISTENSEN S，et al. Favorable venous outflow profiles correlate with favorable tissue-level collaterals and clinical outcome[J]. Stroke，2021，52（5）：1761-1767.
[14] MEI J，SALIM H A，LAKHANI D A，et al. Integrating perfusion imaging derived venous outflow and tissue-level collateral parameters in a comprehensive clinical model enhances prognostication in large vessel occlusion stroke[J/OL]. Neurotherapeutics，2025，22（5）：e00632[2025-10-11]. https://doi.org/10.1016/j.neurot.2025.e00632.
[15] PIEDADE G S，SCHIRMER C M，GOREN O，et al. Cerebral collateral circulation：a review in the context of ischemic stroke and mechanical thrombectomy[J/OL]. World Neurosurg，2019，122：33-42[2025-10-11]. https://doi.org/10.1016/j.wneu.2018.10.066.
[16] LIEBESKIND D S. Collateral perfusion：time for novel paradigms in cerebral ischemia[J]. Int J Stroke，2012，7（4）：309-310.
[17] DE HAVENON A，MLYNASH M，KIM-TENSER M A，et al. Results from DEFUSE 3：good collaterals are associated with reduced ischemic core growth but not neurologic outcome[J]. Stroke，2019，50（3）：632-638.
[18] VAN HORN N，HEIT J J，KABIRI R，et al. Venous outflow profiles are associated with early edema progression in ischemic stroke[J]. Int J Stroke，2022，17（10）：1078-1084.
[19] BARON J C. The core/penumbra model：implications for acute stroke treatment and patient selection in 2021[J]. Eur J Neurol，2021，28（8）：2794-2803.
[20] ALPERIN N. MR-intracranial compliance and pressure：a method for noninvasive measurement of important neurophysiologic parameters[J/OL]. Methods Enzymol，2004，386：323-349[2025-10-11]. https://doi.org/10.1016/S0076-6879(04)86016-6.
[21] 李思源，洪澜，刘心雨，等. 缺血区皮质静脉引流与前循环大血管闭塞性卒中无效再通的关联[J]. 中华医学杂志，2023，103（29）：2210-2217.
LI S Y，HONG L，LIU X Y，et al. The association between cortical venous outflow and futile recanalization in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation[J]. Natl Med J China，2023，103（29）：2210-2217.
[22] BOERS A M M，SALES BARROS R，JANSEN I G H，et al. Value of quantitative collateral scoring on CT angiography in patients with acute ischemic stroke[J]. AJNR Am J Neuroradiol，2018，39（6）：1074-1082.
[23] JIANG S Y，GONG C，HUANG L P，et al. The benefit of favorable venous outflow profiles is mediated through the reduced risk of intracranial hemorrhage in acute ischemic stroke patients undergoing endovascular treatment[J]. J Neurointerv Surg，2025，17（9）：967-973.
[24] WINKELMEIER L，HEIT J J，ADUSUMILLI G，et al. Poor venous outflow profiles increase the risk of reperfusion hemorrhage after endovascular treatment[J]. J Cereb Blood Flow Metab，2023，43（1）：72-83.
[25] LARSEN K，JÆGER H S，HOV M R，et al. Streamlining acute stroke care by introducing National Institutes of Health stroke scale in the emergency medical services：a prospective cohort study[J]. Stroke，2022，53（6）：2050-2057.
[26] KIM-TENSER M，MLYNASH M，LANSBERG M G，et al. CT perfusion core and ASPECT score prediction of outcomes in DEFUSE 3[J]. Int J Stroke，2021，16（3）：288-294.
[27] CHEN X Y，LIN S S，ZHANG X X，et al. Prognosis with non-contrast CT and CT perfusion imaging in thrombolysis-treated acute ischemic stroke[J/OL]. Eur J Radiol，2022，149：110217[2025-10-11]. https://doi.org/10.1016/j.ejrad.2022.110217.