Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes

Hamza Adel Salim; Dhairya A. Lakhani; Aneri B. Balar; Janet Mei; Licia Luna; Mona Shahriari; Nathan Z. Hyson; Francis Deng; Adam A. Dmytriw; Adrien Guenego; Victor C. Urrutia; Elisabeth B. Marsh; Hanzhang Lu; Risheng Xu; Rich Leigh; Gaurang Shah; Sijin Wen; Gregory W. Albers; Argye E. Hillis; Rafael Llinas; Kambiz Nael; Max Wintermark; Jeremy J. Heit; Tobias D. Faizy; Vivek S. Yedavalli

doi:10.1111/jon.70006

Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes

Hamza Adel Salim, Dhairya A. Lakhani, Aneri B. Balar, Janet Mei, Licia Luna, Mona Shahriari, Nathan Z. Hyson, Francis Deng, Adam A. Dmytriw, Adrien Guenego, Victor C. Urrutia, Elisabeth B. Marsh, Hanzhang Lu, Risheng Xu, Rich Leigh, Gaurang Shah, Sijin Wen, Gregory W. Albers, Argye E. Hillis, Rafael LlinasKambiz Nael, Max Wintermark, Jeremy J. Heit, Tobias D. Faizy, Vivek S. Yedavalli

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background and Purpose: Prolonged venous transit (PVT), derived from computed tomography perfusion (CTP) time-to-maximum (T_max) maps, reflects compromised venous outflow (VO) in acute ischemic stroke due to large vessel occlusion (AIS-LVO). Poor VO is associated with worse clinical outcomes, but pre-treatment markers predictive of PVT are not well described. Methods: We conducted a retrospective analysis of 189 patients with anterior circulation AIS-LVO who underwent baseline CT evaluation, including non-contrast CT, CT angiography, and CTP. PVT was assessed on T_max maps; PVT+ was defined as T_max ≥ 10 s within the posterior superior sagittal sinus or torcula. Baseline clinical data were collected. Multivariable logistic regression identified independent associations between pre-treatment markers and PVT. Results: PVT+ was identified in 65 patients (34%). In multivariable analysis, higher admission National Institutes of Health Stroke Scale (NIHSS) scores (adjusted odds ratio [aOR], 1.05 per point; 95% confidence interval [CI], 1.01–1.11; P = 0.028) and male sex (aOR, 1.98; 95% CI, 1.03–3.89; P = 0.043) were independently associated with PVT+. Conclusions: Higher admission NIHSS scores and male sex are independently associated with PVT in anterior circulation AIS-LVO, suggesting that readily available clinical markers may help identify patients with poor VO profiles.

Original language	English (US)
Article number	e70006
Journal	Journal of Neuroimaging
Volume	35
Issue number	1
DOIs	https://doi.org/10.1111/jon.70006
State	Published - Jan 1 2025

Keywords

perfusion imaging
prolonged venous transit
stroke

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Clinical Neurology

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10.1111/jon.70006

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Salim, H. A., Lakhani, D. A., Balar, A. B., Mei, J., Luna, L., Shahriari, M., Hyson, N. Z., Deng, F., Dmytriw, A. A., Guenego, A., Urrutia, V. C., Marsh, E. B., Lu, H., Xu, R., Leigh, R., Shah, G., Wen, S., Albers, G. W., Hillis, A. E., ... Yedavalli, V. S. (2025). Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes. Journal of Neuroimaging, 35(1), Article e70006. https://doi.org/10.1111/jon.70006

Salim, HA, Lakhani, DA, Balar, AB, Mei, J , Luna, L , Shahriari, M , Hyson, NZ , Deng, F, Dmytriw, AA, Guenego, A, Urrutia, VC , Marsh, EB , Lu, H , Xu, R , Leigh, R, Shah, G, Wen, S, Albers, GW, Hillis, AE , Llinas, R, Nael, K, Wintermark, M, Heit, JJ, Faizy, TD & Yedavalli, VS 2025, 'Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes', Journal of Neuroimaging, vol. 35, no. 1, e70006. https://doi.org/10.1111/jon.70006

@article{9dd25a713739400d8feeefd12c735322,

title = "Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes",

abstract = "Background and Purpose: Prolonged venous transit (PVT), derived from computed tomography perfusion (CTP) time-to-maximum (Tmax) maps, reflects compromised venous outflow (VO) in acute ischemic stroke due to large vessel occlusion (AIS-LVO). Poor VO is associated with worse clinical outcomes, but pre-treatment markers predictive of PVT are not well described. Methods: We conducted a retrospective analysis of 189 patients with anterior circulation AIS-LVO who underwent baseline CT evaluation, including non-contrast CT, CT angiography, and CTP. PVT was assessed on Tmax maps; PVT+ was defined as Tmax ≥ 10 s within the posterior superior sagittal sinus or torcula. Baseline clinical data were collected. Multivariable logistic regression identified independent associations between pre-treatment markers and PVT. Results: PVT+ was identified in 65 patients (34%). In multivariable analysis, higher admission National Institutes of Health Stroke Scale (NIHSS) scores (adjusted odds ratio [aOR], 1.05 per point; 95% confidence interval [CI], 1.01–1.11; P = 0.028) and male sex (aOR, 1.98; 95% CI, 1.03–3.89; P = 0.043) were independently associated with PVT+. Conclusions: Higher admission NIHSS scores and male sex are independently associated with PVT in anterior circulation AIS-LVO, suggesting that readily available clinical markers may help identify patients with poor VO profiles.",

keywords = "perfusion imaging, prolonged venous transit, stroke",

author = "Salim, {Hamza Adel} and Lakhani, {Dhairya A.} and Balar, {Aneri B.} and Janet Mei and Licia Luna and Mona Shahriari and Hyson, {Nathan Z.} and Francis Deng and Dmytriw, {Adam A.} and Adrien Guenego and Urrutia, {Victor C.} and Marsh, {Elisabeth B.} and Hanzhang Lu and Risheng Xu and Rich Leigh and Gaurang Shah and Sijin Wen and Albers, {Gregory W.} and Hillis, {Argye E.} and Rafael Llinas and Kambiz Nael and Max Wintermark and Heit, {Jeremy J.} and Faizy, {Tobias D.} and Yedavalli, {Vivek S.}",

note = "Publisher Copyright: {\textcopyright} 2025 American Society of Neuroimaging.",

year = "2025",

month = jan,

day = "1",

doi = "10.1111/jon.70006",

language = "English (US)",

volume = "35",

journal = "Journal of Neuroimaging",

issn = "1051-2284",

publisher = "Wiley-Blackwell",

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TY - JOUR

T1 - Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes

AU - Salim, Hamza Adel

AU - Lakhani, Dhairya A.

AU - Balar, Aneri B.

AU - Mei, Janet

AU - Luna, Licia

AU - Shahriari, Mona

AU - Hyson, Nathan Z.

AU - Deng, Francis

AU - Dmytriw, Adam A.

AU - Guenego, Adrien

AU - Urrutia, Victor C.

AU - Marsh, Elisabeth B.

AU - Lu, Hanzhang

AU - Xu, Risheng

AU - Leigh, Rich

AU - Shah, Gaurang

AU - Wen, Sijin

AU - Albers, Gregory W.

AU - Hillis, Argye E.

AU - Llinas, Rafael

AU - Nael, Kambiz

AU - Wintermark, Max

AU - Heit, Jeremy J.

AU - Faizy, Tobias D.

AU - Yedavalli, Vivek S.

PY - 2025/1/1

Y1 - 2025/1/1

N2 - Background and Purpose: Prolonged venous transit (PVT), derived from computed tomography perfusion (CTP) time-to-maximum (Tmax) maps, reflects compromised venous outflow (VO) in acute ischemic stroke due to large vessel occlusion (AIS-LVO). Poor VO is associated with worse clinical outcomes, but pre-treatment markers predictive of PVT are not well described. Methods: We conducted a retrospective analysis of 189 patients with anterior circulation AIS-LVO who underwent baseline CT evaluation, including non-contrast CT, CT angiography, and CTP. PVT was assessed on Tmax maps; PVT+ was defined as Tmax ≥ 10 s within the posterior superior sagittal sinus or torcula. Baseline clinical data were collected. Multivariable logistic regression identified independent associations between pre-treatment markers and PVT. Results: PVT+ was identified in 65 patients (34%). In multivariable analysis, higher admission National Institutes of Health Stroke Scale (NIHSS) scores (adjusted odds ratio [aOR], 1.05 per point; 95% confidence interval [CI], 1.01–1.11; P = 0.028) and male sex (aOR, 1.98; 95% CI, 1.03–3.89; P = 0.043) were independently associated with PVT+. Conclusions: Higher admission NIHSS scores and male sex are independently associated with PVT in anterior circulation AIS-LVO, suggesting that readily available clinical markers may help identify patients with poor VO profiles.

AB - Background and Purpose: Prolonged venous transit (PVT), derived from computed tomography perfusion (CTP) time-to-maximum (Tmax) maps, reflects compromised venous outflow (VO) in acute ischemic stroke due to large vessel occlusion (AIS-LVO). Poor VO is associated with worse clinical outcomes, but pre-treatment markers predictive of PVT are not well described. Methods: We conducted a retrospective analysis of 189 patients with anterior circulation AIS-LVO who underwent baseline CT evaluation, including non-contrast CT, CT angiography, and CTP. PVT was assessed on Tmax maps; PVT+ was defined as Tmax ≥ 10 s within the posterior superior sagittal sinus or torcula. Baseline clinical data were collected. Multivariable logistic regression identified independent associations between pre-treatment markers and PVT. Results: PVT+ was identified in 65 patients (34%). In multivariable analysis, higher admission National Institutes of Health Stroke Scale (NIHSS) scores (adjusted odds ratio [aOR], 1.05 per point; 95% confidence interval [CI], 1.01–1.11; P = 0.028) and male sex (aOR, 1.98; 95% CI, 1.03–3.89; P = 0.043) were independently associated with PVT+. Conclusions: Higher admission NIHSS scores and male sex are independently associated with PVT in anterior circulation AIS-LVO, suggesting that readily available clinical markers may help identify patients with poor VO profiles.

KW - perfusion imaging

KW - prolonged venous transit

KW - stroke

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U2 - 10.1111/jon.70006

DO - 10.1111/jon.70006

M3 - Article

C2 - 39809719

AN - SCOPUS:85215304439

SN - 1051-2284

VL - 35

JO - Journal of Neuroimaging

JF - Journal of Neuroimaging

IS - 1

M1 - e70006

ER -

Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes

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