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

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

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

1. 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

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