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

Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes JOURNAL OF NEUROIMAGING Salim, H., 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., Llinas, R., Nael, K., Wintermark, M., Heit, J. J., Faizy, T. D., Yedavalli, V. S. 2025; 35 (1): e70006

Abstract

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.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.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+.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.

View details for DOI 10.1111/jon.70006

View details for Web of Science ID 001395781200001

View details for PubMedID 39809719