RT Journal Article
SR Electronic
T1 Prolonged venous transit on perfusion imaging is associated with higher odds of mortality in successfully reperfused patients with large vessel occlusion stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP jnis-2024-021488
DO 10.1136/jnis-2024-021488
A1 Yedavalli, Vivek S
A1 Koneru, Manisha
A1 Hoseinyazdi, Meisam
A1 Greene, Cynthia
A1 Lakhani, Dhairya A
A1 Xu, Risheng
A1 Luna, Licia P
A1 Caplan, Justin M
A1 Dmytriw, Adam A
A1 Guenego, Adrien
A1 Heit, Jeremy J
A1 Albers, Gregory W
A1 Wintermark, Max
A1 Gonzalez, L Fernando
A1 Urrutia, Victor C
A1 Huang, Judy
A1 Nael, Kambiz
A1 Leigh, Richard
A1 Marsh, Elisabeth B
A1 Hillis, Argye E
A1 Llinas, Rafael H
YR 2024
UL http://jnis.bmj.com/content/early/2024/03/12/jnis-2024-021488.abstract
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.