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  • Prolonged venous transit on perfusion imaging is associated with higher odds of mortality in successfully reperfused patients with large vessel occlusion stroke

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Neuroimaging
Original research
Prolonged venous transit on perfusion imaging is associated with higher odds of mortality in successfully reperfused patients with large vessel occlusion stroke
  1. Vivek S Yedavalli1,
  2. Manisha Koneru2,
  3. Meisam Hoseinyazdi1,
  4. Cynthia Greene1,
  5. Dhairya A Lakhani1,
  6. Risheng Xu3,
  7. Licia P Luna1,
  8. Justin M Caplan3,
  9. Adam A Dmytriw4,5,
  10. Adrien Guenego6,
  11. Jeremy J Heit7,8,
  12. Gregory W Albers7,9,
  13. Max Wintermark10,
  14. L Fernando Gonzalez3,
  15. Victor C Urrutia11,
  16. Judy Huang3,
  17. Kambiz Nael12,
  18. Richard Leigh11,
  19. Elisabeth B Marsh11,
  20. Argye E Hillis11,
  21. Rafael H Llinas11
  1. 1Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2Department of Radiology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
  3. 3Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  4. 4Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Neuroradiology and Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
  6. 6Interventional Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
  7. 7Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
  8. 8Radiology, Stanford University, Palo Alto, California, USA
  9. 9Neurology, Stanford University, Palo Alto, California, USA
  10. 10The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  11. 11Neurology, Johns Hopkins Medicine, Baltimore, Maryland, USA
  12. 12Department of Radiology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Vivek S Yedavalli, The Johns Hopkins Hospital, Baltimore, Maryland, USA; vyedava1{at}jhmi.edu

Abstract

Background Poor venous outflow (VO) profiles are associated with unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO), despite achieving successful reperfusion. The objective of this study is to assess the association between mortality and prolonged venous transit (PVT), a novel visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps.

Methods We performed a retrospective analysis of prospectively collected data from consecutive adult patients with AIS-LVO with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s timing on CTP Tmax maps in at least one of the following: superior sagittal sinus (proximal venous drainage) and/or torcula (deep venous drainage). PVT− was defined as lacking this in both regions. The primary outcome was mortality at 90 days. In a 1:1 propensity score-matched cohort, regressions were performed to determine the effect of PVT on 90-day mortality.

Results In 127 patients of median (IQR) age 71 (64–81) years, mortality occurred in a significantly greater proportion of PVT+ patients than PVT− patients (32.5% vs 12.6%, P=0.01). This significant difference persisted after matching (P=0.03). PVT+ was associated with a significantly increased likelihood of 90-day mortality (OR 1.22 (95% CI 1.02 to 1.46), P=0.03) in the matched cohort.

Conclusions PVT+ was significantly associated with 90-day mortality despite successful reperfusion therapy in patients with AIS-LVO. PVT is a simple VO profile marker with potential as an adjunctive metric during acute evaluation of AIS-LVO patients. Future studies will expand our understanding of using PVT in the evaluation of patients with AIS-LVO.

  • CT perfusion
  • stroke
  • vein
  • thrombectomy
  • thrombolysis

Data availability statement

Deidentified data will be made available to qualified investigators on reasonable request to the corresponding author. Data are available upon reasonable request to the corresponding author.

https://doi.org/10.1136/jnis-2024-021488

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    Data availability statement

    Deidentified data will be made available to qualified investigators on reasonable request to the corresponding author. Data are available upon reasonable request to the corresponding author.

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    Footnotes

    • Twitter @vsyedavalli, @ManishaKoneru, @dhairyalakhani, @AdamDmytriw, @GuenegoAdrien, @JeremyHeitMDPHD, @stanfordNRAD, @fegomd, @kambiznael

    • Contributors VSY: conceptualization, methodology, investigation,resources, data curation, writing - original draft, writing - review and editing. MK: methodology, software, formal analysis, writing - review and editing, visualization. MH, CG, DAL, RX, LPL, JMC, AAD, AG, JJH, GWA, MW, LFG, VCU, JH, KN, RL, EBM, AEH, RHL: investigation, resources, data curation, writing - review and editing, supervision, project administration.VSY is guarantor of the paper.

    • Funding This study is supported by the Johns Hopkins University School of Medicine Department of Radiology Physician Scientist Incubator Program (RAD-PSI).

    • Competing interests VSY, JJH and GWA are consultants for iSchemaView (Menlo Park, California, USA) not related to the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.