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Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes

  • 0Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
Annals of Clinical and Translational Neurology +

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November 12, 2024

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November 12, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Prolonged venous transit (PVT), a marker of venous outflow impairment, is linked to reduced neurological improvement in acute ischemic stroke patients with large vessel occlusion (AIS-LVO) even after successful reperfusion. This highlights PVT

Area Of Science

  • Neurology
  • Radiology
  • Medical Imaging

Background

  • Venous outflow (VO) impairment is a predictor of poor outcomes in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).
  • Prolonged venous transit (PVT), identified on CT perfusion (CTP) time to maximum (Tmax) maps, is a visual marker of VO impairment.
  • PVT has been associated with unfavorable functional outcomes at 90 days, even after successful reperfusion therapy.

Purpose Of The Study

  • To investigate the association between PVT and the percent change in the National Institutes of Health Stroke Scale (NIHSS) score.
  • To evaluate PVT as a predictor of neurological improvement in AIS-LVO patients who have undergone successful reperfusion.

Main Methods

  • Retrospective analysis of prospectively collected data from adult AIS-LVO patients with successful reperfusion (TICI 2b/2c/3).
  • PVT was defined as Tmax ≥10 seconds in the superior sagittal sinus, torcula, or both.
  • Primary outcome was continuous and dichotomous (≥70% improvement) NIHSS percent change; regression analyses were used to assess PVT's effect.

Main Results

  • 119 patients were analyzed; PVT+ patients had significantly higher admission and discharge NIHSS scores compared to PVT- patients.
  • After multivariable adjustment, PVT+ was significantly associated with lower NIHSS percent change (B = -0.163, p=0.049).
  • PVT+ was also associated with a lower likelihood of achieving ≥70% NIHSS improvement (OR = 0.331, p=0.024).

Conclusions

  • PVT is significantly associated with reduced neurological improvement in AIS-LVO patients despite successful reperfusion.
  • VO impairment, as indicated by PVT, plays a critical role in short-term functional outcomes.
  • PVT is a valuable imaging biomarker derived from CTP for assessing VO profiles in AIS-LVO.