Prolonged venous transit is associated with lower odds of excellent recovery after reperfusion in anterior large-vessel occlusion stroke

Hamza Adel Salim, Dhairya A. Lakhani, Janet Mei, Licia Luna, Mona Shahriari, Nathan Z. Hyson, Francis Deng, Adam A. Dmytriw, Adrien Guenego, Victor C. Urrutia, Liz Marsh, Hanzhang Lu, Risheng Xu, Richard Leigh, Dylan Wolman, Gaurang Shah, Benjamin Pulli, Gregory W. Albers, Argye E. Hillis, Rafael LlinasKambiz Nael, Max Wintermark, Jeremy J. Heit, Tobias D. Faizy, Vivek Yedavalli

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: Acute ischemic stroke due to anterior circulation large-vessel occlusion (AIS-LVO) remains a leading cause of disability despite successful reperfusion therapies. Prolonged venous transit (PVT) has emerged as a potential prognostic imaging biomarker in AIS-LVO. We aimed to investigate whether PVT is associated with a decreased likelihood of excellent functional outcome (modified Rankin Scale [mRS] score of 0–1 at 90 days) after successful reperfusion. Methods: In our prospectively collected, retrospectively reviewed database, we analyzed data from 104 patients with AIS-LVO who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2b/2c/3) between September 2017 and September 2022. PVT was defined as a time to maximum (Tmax) of ≥10 s in the superior sagittal sinus and/or torcula on computed tomography perfusion (CTP) imaging. Patients were categorized into PVT-positive (PVT+) and PVT-negative (PVT–) groups. The primary outcome was excellent functional recovery at 90 days. Results: Of the 104 patients, 30 (29%) were PVT+. Excellent functional outcome was achieved in 38 patients (37%). PVT+ patients had a significantly lower rate of excellent recovery compared to PVT– patients (11% vs. 39%; p < 0.001). After adjusting for possible confounders, PVT positivity was independently associated with lower odds of excellent recovery (adjusted odds ratio 0.11, 95% confidence interval 0.02 to 0.48; p = 0.006). Conclusions: Among patients with AIS-LVO who achieved successful reperfusion, PVT positivity was independently associated with a decreased likelihood of excellent functional outcome at 90 days. Assessment of PVT on CTP may provide valuable prognostic information and aid in clinical decision making for patients with AIS-LVO.

Original languageEnglish (US)
Article numbere16563
JournalEuropean Journal of Neurology
Volume32
Issue number1
DOIs
StatePublished - Jan 2025

Keywords

  • Acute ischemic stroke (AIS)
  • Computed tomography perfusion (CTP)
  • Intravenous thrombolysis (IVT)
  • Large-vessel occlusion (LVO)
  • Mechanical thrombectomy (MT)
  • Prolonged venous transit (PVT)
  • Venous outflow (VO)

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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