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Review
. 2025 Aug 1.
doi: 10.1007/s00234-025-03722-x. Online ahead of print.

Early venous filling following reperfusion therapy in acute ischemic stroke: a systematic review and meta-analysis

Natan Lucca Lima  1 , Marcos Henrique da Silva Mezzari  2 , Luís Cláudio Izidio Costa Júnior  2 , Davi Orli Machado Grüdtner  2 , Bárbara Ghizoni Maggi  2 , Darlos Kelvin de Azevedo  2 , João Cândido Spezia de Souza  2 , Wilson Jordão Mota Bezerra Júnior  2 , Yasmin Guimarães Rodrigues  2 , Gustavo Rassier Isolan  3
Affiliations
Review

Early venous filling following reperfusion therapy in acute ischemic stroke: a systematic review and meta-analysis

Natan Lucca Lima et al. Neuroradiology. .

Abstract

Background: Early venous filling (EVF), detected by digital subtraction angiography after endovascular therapy, may indicate hyperperfusion and vascular injury. Emerging evidence suggests that EVF is associated with adverse outcomes and complications, highlighting its potential role as a prognostic imaging marker in acute ischemic stroke (AIS).

Methods: A systematic search was conducted in the MEDLINE, Embase, Cochrane Library, and Web of Science databases to identify studies evaluating the outcomes of EVF following reperfusion therapy in cases of AIS. The outcomes included hemorrhagic transformation (HT), parenchymal hematoma (PH), hemorrhagic infarction (HI), symptomatic intracranial hemorrhage (sICH), cerebral infarction as hypodensity on imaging, malignant brain edema (MBE), and unfavorable outcome measured by modified Rankin scale (mRS ≥ 3) after 90 days. A meta-analysis using a random-effects model was conducted to pool the data.

Results: In the data analyses of 12 studies and 2,446 patients, the presence of EVF post-reperfusion was associated with increased risks of HT (odds ratio [OR] = 4.31; 95% confidence interval [CI] [3.00, 6.21]; p < 0.001), PH (OR = 5.73; 95% CI [2.82, 11.65]; p < 0.001), sICH (OR = 6.43; 95% CI [3.49, 8.47]; p < 0.001), cerebral infarction (OR = 15.95; 95% CI [6.37, 39.92]; p < 0.001), MBE (OR = 3.69; 95% CI [2.26, 6.04]; p < 0.001), and unfavorable functional outcomes (OR = 2.58; 95% CI [1.27, 5.23]; p = 0.009).

Conclusions: EVF may serve as a predictor of increased risk of hemorrhagic events, cerebral infarction on imaging, MBE, and unfavorable functional outcomes after brain reperfusion therapy.

Keywords: Early venous filling; Ischemic stroke; Meta-analysis; Reperfusion; Systematic review.

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Conflict of interest statement

Declarations. Ethics approval: Not applicable. Human ethics and consent to participate declarations: Not applicable. Competing interests: The authors declare no competing interests.

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