Prolonged Venous Transit Is Associated With Lower Likelihood of Favorable Clinical Recovery in Reperfused Anterior Circulation Large-Vessel Occlusion Stroke.

Background: Unfavorable clinical outcomes in patients with acute ischemic stroke caused by large-vessel occlusions despite successful reperfusion have been associated with poor venous outflow. The objective of this study is to assess the relationship between prolonged venous transit (PVT), a novel perfusion imaging surrogate for poor venous outflow, and likelihood of favorable clinical recovery. Methods: In this retrospective review of prospectively collected data of consecutive patients (2017-2022) with successfully reperfused, anterior circulation acute ischemic stroke caused by large-vessel occlusions, we assessed the association between PVT+, defined as time to maximum ≧10-second timing delays within either the posterior superior sagittal sinus, torcula, or both regions on pretreatment perfusion imaging, and favorable clinical outcomes defined as 90-day modified Rankin Scale score of 0 to 2. Patients were dichotomized into PVT+ and PVT- for analysis. Multivariable logistic regression analyses for favorable recovery were performed with demographic variables and stroke characteristics. Results: A total of 127 consecutive patients (median age, 71 [interquartile range 61-77] years; 59.1% women) were included, and 40 of 127 (31.5%) were PVT+. PVT+ (adjusted odds ratio [aOR], 0.23 [95% CI, 0.07-0.81]; Conclusion: PVT+ was associated with a lower likelihood of achieving favorable clinical recovery in successfully reperfused patients with acute ischemic stroke caused by large vessel occlusion. PVT may serve as a clinically useful adjunctive imaging parameter.