PT  - JOURNAL ARTICLE
AU  - Yedavalli, Vivek S
AU  - Koneru, Manisha
AU  - Hoseinyazdi, Meisam
AU  - Greene, Cynthia
AU  - Lakhani, Dhairya A
AU  - Xu, Risheng
AU  - Luna, Licia P
AU  - Caplan, Justin M
AU  - Dmytriw, Adam A
AU  - Guenego, Adrien
AU  - Heit, Jeremy J
AU  - Albers, Gregory W
AU  - Wintermark, Max
AU  - Gonzalez, L Fernando
AU  - Urrutia, Victor C
AU  - Huang, Judy
AU  - Nael, Kambiz
AU  - Leigh, Richard
AU  - Marsh, Elisabeth B
AU  - Hillis, Argye E
AU  - Llinas, Rafael H
TI  - Prolonged venous transit on perfusion imaging is associated with higher odds of mortality in successfully reperfused patients with large vessel occlusion stroke
AID  - 10.1136/jnis-2024-021488
DP  - 2024 Mar 12
TA  - Journal of NeuroInterventional Surgery
PG  - jnis-2024-021488
4099  - http://jnis.bmj.com/content/early/2024/03/12/jnis-2024-021488.short
4100  - http://jnis.bmj.com/content/early/2024/03/12/jnis-2024-021488.full
AB  - 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.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.