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

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, March 26, 2024

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

Are your doctor and hospital prepared with EXACT PROTOCOLS to prevent this from deteriorating to death? You might want to ask this of them NOW instead of hoping they can 'wing it' successfully!

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

http://orcid.org/0000-0002-2450-4014Vivek S Yedavalli1,
http://orcid.org/0000-0001-5012-6793Manisha Koneru2,
Meisam Hoseinyazdi1,
Cynthia Greene1,
http://orcid.org/0000-0001-7577-1887Dhairya A Lakhani1,
Risheng Xu3,
Licia P Luna1,
http://orcid.org/0000-0002-0289-3661Justin M Caplan3,
http://orcid.org/0000-0003-0131-5699Adam A Dmytriw4,5,
http://orcid.org/0000-0001-7281-1652Adrien Guenego6,
http://orcid.org/0000-0003-1055-8000Jeremy J Heit7,8,
Gregory W Albers7,9,
Max Wintermark10,
http://orcid.org/0000-0003-4121-1755L Fernando Gonzalez3,
Victor C Urrutia11,
Judy Huang3,
http://orcid.org/0000-0002-4194-9488Kambiz Nael12,
Richard Leigh11,
Elisabeth B Marsh11,
Argye E Hillis11,
Rafael H Llinas11

Correspondence to Dr Vivek S Yedavalli, The Johns Hopkins Hospital, Baltimore, Maryland, USA; vyedava1@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.

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