• Keisuke Kadooka, Yoshito Arakaki, Yoichi Kikuchi, Hiroki Matsui, Takafumi Mitsutake, Michihiro Tanaka, and Masatou Kawashima.
• Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan; International University of Health and Welfare Graduate School, Narita, Chiba, Japan. Electronic address: kadosan0313@ybb.ne.jp.
• World Neurosurg. 2023 Aug 1; 176: e219e225e219-e225.

BackgroundWhen treating acute ischemic stroke patients, evaluation of collateral flow to the ischemic area is essential. Blood-oxygen-level-dependent imaging, including T2 star (T2∗), can identify elevated deoxyhemoglobin levels, reflecting an increase in the oxygen extraction fraction. Prominent veins on T2∗ represent increased deoxyhemoglobin and cerebral blood volume. This study compared asymmetrical vein signs (AVSs) on T2∗ and digital subtraction angiography findings during mechanical thrombectomy (MT) in patients with hyperacute middle cerebral artery occlusion.MethodsClinical and imaging data of 41 patients with occlusion of the horizontal segment of the middle cerebral artery who underwent MT were collected. Patients were divided into 2 groups based on angiographic occlusion sites as: proximal and distal to the lenticulostriate artery (LSA). AVSs on T2∗ were divided into asymmetrical cortical vein sign (cortical AVS) and asymmetrical deep/medullary vein sign (deep/medullary AVS), and were compared with the findings of intraoperative digital subtraction angiography.ResultsTwenty-seven patients had AVSs. Cortical AVS was the only parameter with a significant association with poor angiographic collateral supply. In terms of occlusion site, deep/medullary AVS was the only parameter with a significant association with occlusion proximal to the LSA.ConclusionsIn patients with occlusion of the horizontal segment of the middle cerebral artery, presence of the cortical AVS on T2∗ suggests a poor angiographic collateral supply, while presence of the deep/medullary AVS suggests impaired blood flow to the basal ganglia through LSAs. Both these signs contribute to poor outcomes in patients undergoing MT.Copyright © 2023 Elsevier Inc. All rights reserved.

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