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Prolonged venous transit and clinical outcomes in anterior circulation large-vessel occlusion stroke with complete or near-complete reperfusion.

Prolonged venous transit and clinical outcomes in anterior circulation large-vessel occlusion stroke with complete or near-complete reperfusion. Neuroradiology Salim, H. A., Lakhani, D. A., Balar, A., 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. 2025

Abstract

BACKGROUND: Prolonged venous transit (PVT), indicative of impaired venous outflow, is linked to poor outcomes in acute ischemic stroke due to large-vessel occlusion (AIS-LVO) treated with mechanical thrombectomy (MT). This study investigated the prognostic significance of PVT in AIS-LVO patients achieving near-complete or complete reperfusion (mTICI 2c or 3).METHODS: Retrospective analysis of a prospective registry included AIS-LVO patients with anterior circulation occlusions, mTICI 2c or 3 after MT, and 90-day modified Rankin Scale (mRS) scores. PVT, defined as Tmax=10s in the posterior superior sagittal sinus or torcula on pretreatment CT perfusion, was assessed. Outcomes were favorable recovery (mRS 0-2), excellent recovery (mRS 0-1), and 90-day mortality.RESULTS: Among 81 patients, 25 (31%) were PVT+and 56 (69%) were PVT-. Baseline characteristics were similar. PVT+patients had higher discharge NIH Stroke Scale scores and worse 90-day mRS scores (median mRS, 4.00 vs. 1.00; P<0.001). Multivariable analysis showed PVT+independently predicted lower odds of favorable (OR, 0.18; 95% CI, 0.04-0.65; P=0.013) and excellent outcomes (OR, 0.12; 95% CI, 0.02-0.52; P=0.008) and higher 90-day mortality (OR, 4.11; 95% CI, 1.08-17.0; P=0.041).CONCLUSIONS: PVT is a strong negative prognostic marker in AIS-LVO patients with excellent reperfusion, associated with reduced functional recovery and increased 90-day mortality. PVT assessment may identify high-risk patients despite successful MT.

View details for DOI 10.1007/s00234-025-03799-4

View details for PubMedID 41182415