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; Elisabeth B Marsh; Hanzhang Lu; Risheng Xu; Rich Leigh; Dylan Wolman; Gaurang Shah; Benjamin Pulli; Gregory W Albers; Argye E Hillis; Rafael Llinas; Kambiz Nael; Max Wintermark; Jeremy J Heit; Tobias D Faizy; Vivek Yedavalli

doi:10.1111/ene.16563

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

Eur J Neurol. 2025 Jan;32(1):e16563. doi: 10.1111/ene.16563.

Authors

Hamza Adel Salim^{1

2}, Dhairya A Lakhani^{1

3}, Janet Mei¹, Licia Luna¹, Mona Shahriari¹, Nathan Z Hyson¹, Francis Deng¹, Adam A Dmytriw^{4

5}, Adrien Guenego⁶, Victor C Urrutia¹, Elisabeth B Marsh¹, Hanzhang Lu¹, Risheng Xu¹, Rich Leigh¹, Dylan Wolman⁷, Gaurang Shah⁸, Benjamin Pulli⁹, Gregory W Albers⁹, Argye E Hillis¹, Rafael Llinas¹, Kambiz Nael¹⁰, Max Wintermark², Jeremy J Heit⁹, Tobias D Faizy¹¹, Vivek Yedavalli¹

Affiliations

¹ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
² Department of Neuroradiology, MD Anderson Medical Center, Houston, Texas, USA.
³ Department of Radiology, West Virginia University, Morgantown, West Virginia, USA.
⁴ Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
⁵ Neurovascular Centre, Department of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.
⁶ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
⁷ Department of Radiology, Brown University, Providence, Rhode Island, USA.
⁸ Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
⁹ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA.
¹⁰ Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA.
¹¹ Department of Radiology, Neuroendovascular Program, University Medical Center, Münster, Germany.

PMID: 39620268
DOI: 10.1111/ene.16563

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.

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).