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Background <p>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).</p> Methods <p>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 ≥ 10&#xa0;s 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.</p> Results <p>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; <i>P</i> &lt; 0.001). Multivariable analysis showed PVT + independently predicted lower odds of favorable (OR, 0.18; 95% CI, 0.04–0.65; <i>P</i> = 0.013) and excellent outcomes (OR, 0.12; 95% CI, 0.02–0.52; <i>P</i> = 0.008) and higher 90-day mortality (OR, 4.11; 95% CI, 1.08-17.0; <i>P</i> = 0.041).</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Hamza Adel Salim,
  • Dhairya A. Lakhani,
  • Aneri Balar,
  • 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,
  • Gaurang Shah,
  • Sijin Wen,
  • Gregory W Albers,
  • Argye E. Hillis,
  • Rafael Llinas,
  • Kambiz Nael,
  • Max Wintermark,
  • Jeremy J. Heit,
  • Tobias D. Faizy,
  • Vivek Yedavalli

摘要

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 ≥ 10 s 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.