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Background and Purpose <p>Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT), a&#xa0;visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with 90-day mortality despite successful reperfusion. This study investigates the association between PVT and modified Rankin Scale (mRS) score at discharge among AIS-LVO patients who have undergone successful reperfusion.</p> Methods <p>We performed a&#xa0;retrospective analysis of prospectively collected data from consecutive adult AIS-LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥ 10 s in at least one of the following locations: superior sagittal sinus and/or torcula. The primary outcome was dichotomous mRS scores at discharge (favorable: mRS 0–2; unfavorable: mRS 3–6). Regression analyses were performed to assess the effect of PVT on discharge mRS.</p> Results <p>In 119 patients of median (IQR) age&#xa0;71 (63–81) years, a&#xa0;significantly higher proportion of PVT+ patients exhibited unfavorable mRS scores compared to PVT− patients (88.8% vs. 62.7%, <i>p</i> = 0.004). After adjusting for age, sex, hyperlipidemia, diabetes, history of stroke or transient ischemic attack (TIA), tobacco use, administration of intravenous thrombolysis (IVT), admission National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT (ASPECTS) score, and ischemic core volume, the PVT+ remains significantly associated with unfavorable mRS (OR = 0.231, 95%CI 0.054–0.980, <i>p</i> = 0.047).</p> Conclusions <p>PVT+ was significantly associated with unfavorable mRS at discharge despite successful reperfusion in AIS-LVO patients, underscoring the importance of VO impairment in short-term functional outcomes. PVT serves as a&#xa0;valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS-LVO.</p>

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Prolonged Venous Transit Independently Predicts Worse Functional Outcomes at Discharge in Successfully Reperfused Patients with Large Vessel Occlusion Stroke

  • 期刊论文

  • 发表日期：

    2025年4月1日

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  • Janet Mei,
  • Hamza A. Salim,
  • Dhairya A. Lakhani,
  • Aneri Balar,
  • Adam A. Dmytriw,
  • Meisam Hoseinyazdi,
  • Licia Luna,
  • Francis Deng,
  • Vaibhav Vagal,
  • Nathan Z. Hyson,
  • Adrien Guenego,
  • Gregory W. Albers,
  • Hanzhang Lu,
  • Victor C. Urrutia,
  • Kambiz Nael,
  • Elisabeth B. Marsh,
  • Argye E. Hillis,
  • Raf Llinas,
  • Max Wintermark,
  • Jeremy J. Heit,
  • Tobias D. Faizy,
  • Vivek Yedavalli

摘要

Background and Purpose

Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with 90-day mortality despite successful reperfusion. This study investigates the association between PVT and modified Rankin Scale (mRS) score at discharge among AIS-LVO patients who have undergone successful reperfusion.

Methods

We performed a retrospective analysis of prospectively collected data from consecutive adult AIS-LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥ 10 s in at least one of the following locations: superior sagittal sinus and/or torcula. The primary outcome was dichotomous mRS scores at discharge (favorable: mRS 0–2; unfavorable: mRS 3–6). Regression analyses were performed to assess the effect of PVT on discharge mRS.

Results

In 119 patients of median (IQR) age 71 (63–81) years, a significantly higher proportion of PVT+ patients exhibited unfavorable mRS scores compared to PVT− patients (88.8% vs. 62.7%, p = 0.004). After adjusting for age, sex, hyperlipidemia, diabetes, history of stroke or transient ischemic attack (TIA), tobacco use, administration of intravenous thrombolysis (IVT), admission National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT (ASPECTS) score, and ischemic core volume, the PVT+ remains significantly associated with unfavorable mRS (OR = 0.231, 95%CI 0.054–0.980, p = 0.047).

Conclusions

PVT+ was significantly associated with unfavorable mRS at discharge despite successful reperfusion in AIS-LVO patients, underscoring the importance of VO impairment in short-term functional outcomes. PVT serves as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS-LVO.