{
  "abstract": "Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating disease with poorly understood underlying mechanisms for secondary injury. Venous outflow is essential for proper intracranial circulation and cerebrospinal fluid drainage. A cortical venous opacification score (COVES) has been developed as an assessment of venous drainage, as measured on CT angiography, and has been validated and extensively correlated with ischemic stroke outcomes. Along the same lines a number of recent studies have attempted to correlate COVES with secondary injury and outcomes in patients with aSAH.Objectives In this study with we aim to evaluate the association between venous filling as determined by COVES and more comprehensive venous scores and the occurrence of secondary injury as well as final outcomes in patients with aSAH.Methods This is a retrospective single tertiary center cohort study of all patients admitted with aSAH between 2021 and 2023. Admission CT angiography was used to measure initial bilateral COVES as well as opacification of bilateral vein of Tolard, internal cerebral veins, and basal vein of Rosenthal. Each vein measured was given a score of 0, no opacification, 1, partial opacification or 2, complete opacification. CT angiography was reviewed blinded to patients’ clinical course. Bilateral COVES, superficial venous score (COVES+ vein of Tolard), deep venous score (Internal cerebral veins+ Basal vein of Rosenthal) and total venous score (sum of all measured venous opacification scores) were correlated with admission clinical and radiographic parameters as well as secondary injury events and outcomes at final follow-up using modified Rankin scale (mRs). mRs was dichotomized to good outcome mRs 0-3 and poor outcome 4-6.Results A total of 72 patients were included in this study after excluding patients without long-term follow-up or poor resolution CT angiography on admission. Median age was 55.25 with 58% female patients. Median length of follow-up was 9.3 months (Range 2-34 months). Median Hunt&Hess (HH) grade was 4(Range: 1-5) and Media Fisher grade also 4 (Range: 1-5). On univariate analysis, Poor deep venous scores correlated with need for EVD on initial admission, p=0.015. In addition, COVES, superficial venous scores, and total venous scores correlated with modified rankin score (mRs) at last follow-up, p=.011, 0.004, and .007 respectively. On multivariable logistic regression analysis controlling for age, HH, fisher grade, and need for initial or permanent CSF diversion all venous opacification scores significantly correlated with mRs at last follow-up. The occurrence of DCI, vasospasm or need for CSF diversion did not correlate with venous scores on multivariable analysis.Conclusion Venous opacification scores on admission CT angiography as a marker of venous outflow are associated with overall outcomes in patients with aSAH. This highlights the importance of venous drainage in the pathophysiology of aSAH. Further large cohort, prospective studies are required for validation.Disclosures A. Helal: None. Y. Zhou: None. F. Zach: None. J. Seinfeld: None. C. Roark: None. D. Case: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "A Helal"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO"
      ],
      "name": "R Moseley"
    },
    {
      "affiliations": [
        "University of Colorado, Aurora, CO"
      ],
      "name": "M Salem"
    },
    {
      "affiliations": [
        "College of Osteopathic Medicine, Rocky Vista University, Parker, CO"
      ],
      "name": "H Granberg"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "Y Zhou"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "F Zach"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "J Seinfeld"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "C Roark"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "D Case"
    }
  ],
  "title": "E-066 Venous opacification scores as a predictor of long-term outcomes in patients with aneurysmal subarachnoid hemorrhage",
  "uid": "5d592d4c-79b0-579d-90f3-7191633277c1"
}