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Review
. 2025 Jul 8.
doi: 10.1007/s00234-025-03688-w. Online ahead of print.

Prognostic value of cerebral venous outflow profiles for outcomes prediction following reperfusion therapy in acute ischemic stroke: a meta-analysis

Hesham Kelani  1 , Mohamed R Abdelraouf  2 , Shree Rath  3 , Shrouk F Mohamed  4 , Hazem Mohamed Salamah  5 , Qasim Mehmood  6 , Muhammad Ansab  7 , Danisha Kumar  8 , Ahmed Abd Elazim  9 , Diana Greene-Chandos  10 , Ketevan Berekashvili  11 , Ambooj Tiwari  12 , Volodymyr Vulkanov  13 , David P Lerner  14 , Eytan Raz  15
Affiliations
Review

Prognostic value of cerebral venous outflow profiles for outcomes prediction following reperfusion therapy in acute ischemic stroke: a meta-analysis

Hesham Kelani et al. Neuroradiology. .

Abstract

Background: Recent studies have suggested that favorable venous outflow (VO) may be a promising imaging biomarker to predict clinical outcomes following reperfusion therapy in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO).

Methods: A comprehensive literature search was conducted in PubMed, Scopus, WOS, and Cochrane to identify studies that evaluated VO profiles, assessed using the Cortical Vein Opacification Score (COVES). The risk ratio (RR) and 95% confidence interval (CI) for the outcomes, including functional independence, assessed by modified rankin scale at 90 days (mRS 0-2), hemorrhagic infarction, parenchymal hematoma, 90-day mortality, intracranial hemorrhage (ICH), and symptomatic ICH (sICH), were calculated and analyzed using the 'meta' package in R version 4.4.1.

Results: A total of six studies encompassing 2249 patients were included. Patients with favorable VO had a higher likelihood of achieving functional independence at 90 days (RR = 2.15; 95% CI: 1.35, 3.42; p = 0.01) and a lower incidence of 90-day mortality (RR = 0.39; 95% CI: 0.30, 0.51; p < 0.01), parenchymal hematoma (RR = 0.36; 95% CI: 0.27, 0.47; p < 0.01). Furthermore, sICH was less frequent in patients with favorable VO (RR = 0.39; 95% CI: 0.17, 0.89; p = 0.03). However, hemorrhagic infarction and any ICH did not differ significantly between the two groups (p-values: 0.06 and 0.32, respectively).

Conclusion: VO is a promising imaging biomarker for predicting outcomes in patients with AIS-LVO following reperfusion therapy. Prospective clinical trials are warranted to investigate the predictive value of VO, assessed on multiphasic computed tomography angiography (CTA), as a prognostic marker in this patient population.

Keywords: Acute ischemic stroke; Biomarker; COVES; Intracranial hemorrhage; Reperfusion therapy; Thrombectomy; Venous outflow.

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Conflict of interest statement

Declarations. Ethical approval: Not applicable. Consent of participation: Not applicable. Competing interests: The authors declare no competing interests.

References

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