Prolonged Venous Transit Is Associated With Lower Likelihood of Favorable Clinical Recovery in Reperfused Anterior Circulation Large‐Vessel Occlusion Stroke
Vivek Yedavalli, Manisha Koneru, Aneri Balar, Dhairya A. Lakhani, Andrew Cho, Sijin Wen, Yanqing Mei, Meisam Hoseinyazdi, Cynthia Greene, Risheng Xu, Licia Luna, Justin M. Caplan, Adam A. Dmytriw, Adrien Guenego, Jeremy J Heit, Gregory W. Albers, Max Wintermark, Luis Fernando Muñoz González, Victor Urrutia, Judy Huang, Kambiz Nael, Tobias D. Faizy, Richard Leigh, Elisabeth B. Marsh, Argye E. Hillis, R. Llinás
Abstract
Background: Unfavorable clinical outcomes in patients with acute ischemic stroke caused by large-vessel occlusions despite successful reperfusion have been associated with poor venous outflow. The objective of this study is to assess the relationship between prolonged venous transit (PVT), a novel perfusion imaging surrogate for poor venous outflow, and likelihood of favorable clinical recovery. Methods: In this retrospective review of prospectively collected data of consecutive patients (2017-2022) with successfully reperfused, anterior circulation acute ischemic stroke caused by large-vessel occlusions, we assessed the association between PVT+, defined as time to maximum ≧10-second timing delays within either the posterior superior sagittal sinus, torcula, or both regions on pretreatment perfusion imaging, and favorable clinical outcomes defined as 90-day modified Rankin Scale score of 0 to 2. Patients were dichotomized into PVT+ and PVT- for analysis. Multivariable logistic regression analyses for favorable recovery were performed with demographic variables and stroke characteristics. Results: = 0.01) were significantly associated with the primary outcome. Conclusion: PVT+ was associated with a lower likelihood of achieving favorable clinical recovery in successfully reperfused patients with acute ischemic stroke caused by large vessel occlusion. PVT may serve as a clinically useful adjunctive imaging parameter.