The Cortical Vein Opacification Score Is Independently Associated with Good and Excellent Functional Outcomes at 90 Days in Patients with Minor Stroke with Anterior Circulation Large-Vessel Occlusion: A Multicenter Study

BACKGROUND AND PURPOSE: There is currently no consensus on the most appropriate emergent treatment for patients with acute ischemic stroke secondary to large-vessel occlusion and minor stroke. These patients were excluded from prior randomized controlled trials assessing the efficacy of mechanical thrombectomy in large-vessel occlusion, making it challenging to determine the best treatment approach. Therefore, identifying markers that can predict functional outcomes would be invaluable for triaging these patients for mechanical thrombectomy. This study aimed to investigate pretreatment clinical and imaging markers and their association with functional outcomes at 90 days in patients with minor acute ischemic stroke secondary to large-vessel occlusion (AIS-LVO). MATERIALS AND METHODS: We included patients with AIS-LVO and minor strokes from 4 sites across North America and Europe. Minor stroke was defined as a baseline NIHSS score of #5. The primary outcome measure, good functional outcome, was defined as an mRS score of 0-2 at 90 days. The secondary outcome, excellent functional outcome, was defined as an mRS score of 0-1 at 90 days. Univariable and multivariable logistic regression analyses, along with receiver operating characteristic curve analysis, were performed. RESULTS: Among 168 consecutive patients with minor strokes, 123 achieved a good functional outcome, and 103 patients had an excellent functional outcome at 90 days. The cortical vein opacification score (COVES) was independently associated with both excellent and good functional outcomes, whereas no other CT, CTA, or CTP markers showed a significant association with these outcomes. Receiver operating characteristic analysis of COVES showed an area under the curve of 0.638 (95% CI, 0.517-0.759; P = .026) for predicting a good functional outcome and 0.689 (95% CI, 0.537-0.741; P = .008) for predicting an excellent functional outcome. Similar results were observed in the subgroup of patients who underwent mechanical thrombectomy. Most interesting, neither IV thrombolysis nor mechanical thrombectomy was associated with functional outcomes. CONCLUSIONS: Our analysis demonstrates that COVES is independently associated with good and excellent functional outcomes at 90 days in cases of minor AIS-LVO. Further prospective studies are needed to better understand the role of COVES in determining optimal management strategies for these patients.