Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes
Abstract Objective Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS‐LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated wit...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-01-01
|
| Series: | Annals of Clinical and Translational Neurology |
| Online Access: | https://doi.org/10.1002/acn3.52243 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832592624199925760 |
|---|---|
| author | Janet Mei Hamza Adel Salim Dhairya A. Lakhani Licia Luna Aneri Balar Mona Shahriari Nathan Z. Hyson Francis Deng Adam A. Dmytriw Adrien Guenego Vaibhav Vagal Victor C. Urrutia Elisabeth B. Marsh Hanzhang Lu Risheng Xu Rich Leigh Dylan Wolman Gaurang Shah Benjamin Pulli Kambiz Nael Gregory W. Albers Max Wintermark Jeremy J. Heit Tobias D. Faizy Argye E. Hillis Raf Llinas Vivek Yedavalli |
| author_facet | Janet Mei Hamza Adel Salim Dhairya A. Lakhani Licia Luna Aneri Balar Mona Shahriari Nathan Z. Hyson Francis Deng Adam A. Dmytriw Adrien Guenego Vaibhav Vagal Victor C. Urrutia Elisabeth B. Marsh Hanzhang Lu Risheng Xu Rich Leigh Dylan Wolman Gaurang Shah Benjamin Pulli Kambiz Nael Gregory W. Albers Max Wintermark Jeremy J. Heit Tobias D. Faizy Argye E. Hillis Raf Llinas Vivek Yedavalli |
| author_sort | Janet Mei |
| collection | DOAJ |
| description | Abstract Objective Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS‐LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with unfavorable 90‐day functional outcomes despite successful reperfusion. This study investigates the association between PVT and percent change on the National Institutes of Health Stroke Scale (NIHSS) among AIS‐LVO patients who have undergone successful reperfusion. Methods We performed a retrospective analysis of prospectively collected data from consecutive adult AIS‐LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s in the superior sagittal sinus, torcula, or both. The primary outcome was continuous NIHSS percent change and dichotomous NIHSS percent change ≥70%. Regression analyses were performed to assess the effect of PVT on NIHSS percent change. Results In 119 patients of median (IQR) age 71 (63–81) years, the admission and discharge NIHSS scores were significantly higher in PVT+ patients compared to PVT− patients (17 [14–23.5] vs. 13 [9.5–19], p = 0.011, and 7.5 [4–12] vs. 3 [1–7], p < 0.001, respectively). After adjusting for age, sex, hypertension, diabetes, atrial fibrillation, administration of intravenous thrombolysis (IVT), Alberta Stroke Program Early CT Scores (ASPECTS), mTICI 2c and/or 3, Tmax >6 s volume, and hemorrhagic transformation, PVT+ was significantly associated with lower NIHSS percent change (B = −0.163, 95%CI −0.326 to −0.001, p = 0.049) and was less likely to achieve higher than 70% NIHSS improvement (OR = 0.331, 95% CI 0.127–0.863, p = 0.024). Interpretation PVT+ was significantly associated with reduced neurological improvement despite successful reperfusion in AIS‐LVO patients, highlighting the critical role of VO impairment in short‐term functional outcomes. These findings further validate PVT as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS‐LVO. |
| format | Article |
| id | doaj-art-1942eeebade6470f91acce754984dee7 |
| institution | Kabale University |
| issn | 2328-9503 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Clinical and Translational Neurology |
| spelling | doaj-art-1942eeebade6470f91acce754984dee72025-01-21T05:41:42ZengWileyAnnals of Clinical and Translational Neurology2328-95032025-01-01121263310.1002/acn3.52243Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokesJanet Mei0Hamza Adel Salim1Dhairya A. Lakhani2Licia Luna3Aneri Balar4Mona Shahriari5Nathan Z. Hyson6Francis Deng7Adam A. Dmytriw8Adrien Guenego9Vaibhav Vagal10Victor C. Urrutia11Elisabeth B. Marsh12Hanzhang Lu13Risheng Xu14Rich Leigh15Dylan Wolman16Gaurang Shah17Benjamin Pulli18Kambiz Nael19Gregory W. Albers20Max Wintermark21Jeremy J. Heit22Tobias D. Faizy23Argye E. Hillis24Raf Llinas25Vivek Yedavalli26Division of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USANeuroendovascular Program, Massachusetts General Hospital Harvard University Boston Massachusetts USADepartment of Diagnostic and Interventional Neuroradiology Erasme University Hospital Brussels BelgiumRenaissance School of Medicine at Stony Brook University Stony Brook New York USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADepartment of Radiology Brown University Providence Rhode Island USADepartment of Radiology, Division of Neuroradiology University of Michigan Ann Arbor Michigan USADepartment of Interventional Neuroradiology Stanford Medical Center Palo Alto California USADepartment of Radiology & Biomedical Imaging University of California San Francisco California USADepartment of Interventional Neuroradiology Stanford Medical Center Palo Alto California USADepartment of Neuroradiology MD Anderson Medical Center Houston Texas 77030 USADepartment of Interventional Neuroradiology Stanford Medical Center Palo Alto California USADepartment of Radiology, Neuroendovascular Program University Medical Center Münster GermanyDivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USADivision of Neuroradiology, Department of Radiology Johns Hopkins Medical Center Baltimore Maryland USAAbstract Objective Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS‐LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with unfavorable 90‐day functional outcomes despite successful reperfusion. This study investigates the association between PVT and percent change on the National Institutes of Health Stroke Scale (NIHSS) among AIS‐LVO patients who have undergone successful reperfusion. Methods We performed a retrospective analysis of prospectively collected data from consecutive adult AIS‐LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s in the superior sagittal sinus, torcula, or both. The primary outcome was continuous NIHSS percent change and dichotomous NIHSS percent change ≥70%. Regression analyses were performed to assess the effect of PVT on NIHSS percent change. Results In 119 patients of median (IQR) age 71 (63–81) years, the admission and discharge NIHSS scores were significantly higher in PVT+ patients compared to PVT− patients (17 [14–23.5] vs. 13 [9.5–19], p = 0.011, and 7.5 [4–12] vs. 3 [1–7], p < 0.001, respectively). After adjusting for age, sex, hypertension, diabetes, atrial fibrillation, administration of intravenous thrombolysis (IVT), Alberta Stroke Program Early CT Scores (ASPECTS), mTICI 2c and/or 3, Tmax >6 s volume, and hemorrhagic transformation, PVT+ was significantly associated with lower NIHSS percent change (B = −0.163, 95%CI −0.326 to −0.001, p = 0.049) and was less likely to achieve higher than 70% NIHSS improvement (OR = 0.331, 95% CI 0.127–0.863, p = 0.024). Interpretation PVT+ was significantly associated with reduced neurological improvement despite successful reperfusion in AIS‐LVO patients, highlighting the critical role of VO impairment in short‐term functional outcomes. These findings further validate PVT as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS‐LVO.https://doi.org/10.1002/acn3.52243 |
| spellingShingle | Janet Mei Hamza Adel Salim Dhairya A. Lakhani Licia Luna Aneri Balar Mona Shahriari Nathan Z. Hyson Francis Deng Adam A. Dmytriw Adrien Guenego Vaibhav Vagal Victor C. Urrutia Elisabeth B. Marsh Hanzhang Lu Risheng Xu Rich Leigh Dylan Wolman Gaurang Shah Benjamin Pulli Kambiz Nael Gregory W. Albers Max Wintermark Jeremy J. Heit Tobias D. Faizy Argye E. Hillis Raf Llinas Vivek Yedavalli Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes Annals of Clinical and Translational Neurology |
| title | Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes |
| title_full | Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes |
| title_fullStr | Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes |
| title_full_unstemmed | Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes |
| title_short | Prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes |
| title_sort | prolonged venous transit is associated with worse neurological recovery in successfully reperfused large vessel strokes |
| url | https://doi.org/10.1002/acn3.52243 |
| work_keys_str_mv | AT janetmei prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT hamzaadelsalim prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT dhairyaalakhani prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT licialuna prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT aneribalar prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT monashahriari prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT nathanzhyson prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT francisdeng prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT adamadmytriw prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT adrienguenego prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT vaibhavvagal prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT victorcurrutia prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT elisabethbmarsh prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT hanzhanglu prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT rishengxu prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT richleigh prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT dylanwolman prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT gaurangshah prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT benjaminpulli prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT kambiznael prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT gregorywalbers prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT maxwintermark prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT jeremyjheit prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT tobiasdfaizy prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT argyeehillis prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT rafllinas prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes AT vivekyedavalli prolongedvenoustransitisassociatedwithworseneurologicalrecoveryinsuccessfullyreperfusedlargevesselstrokes |