Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio
Background Collateral status plays a crucial role in outcomes after acute ischemic stroke due to large vessel occlusion. Tissue‐level collaterals and venous outflow are key components following mechanical thrombectomy. This study evaluates the predictive performance of prolonged venous transit (PVT)...
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2025-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039924 |
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| author | Janet Mei Hamza Adel Salim Dhairya A. Lakhani Aneri Balar Vaibhav Vagal Manisha Koneru Dylan Wolman Risheng Xu Victor Urrutia Elisabeth Breese Marsh Benjamin Pulli Meisam Hoseinyazdi Licia Luna Francis Deng Nathan Z. Hyson Mona Shahriari Adam A. Dmytriw Adrien Guenego Gregory W. Albers Hanzhang Lu Kambiz Nael Argye E. Hillis Rafael Llinas Max Wintermark Tobias D. Faizy Jeremy J. Heit Vivek Yedavalli |
| author_facet | Janet Mei Hamza Adel Salim Dhairya A. Lakhani Aneri Balar Vaibhav Vagal Manisha Koneru Dylan Wolman Risheng Xu Victor Urrutia Elisabeth Breese Marsh Benjamin Pulli Meisam Hoseinyazdi Licia Luna Francis Deng Nathan Z. Hyson Mona Shahriari Adam A. Dmytriw Adrien Guenego Gregory W. Albers Hanzhang Lu Kambiz Nael Argye E. Hillis Rafael Llinas Max Wintermark Tobias D. Faizy Jeremy J. Heit Vivek Yedavalli |
| author_sort | Janet Mei |
| collection | DOAJ |
| description | Background Collateral status plays a crucial role in outcomes after acute ischemic stroke due to large vessel occlusion. Tissue‐level collaterals and venous outflow are key components following mechanical thrombectomy. This study evaluates the predictive performance of prolonged venous transit (PVT), cerebral blood volume index, and hypoperfusion intensity ratio in determining 90‐day functional outcomes. METHODS AND RESULTS We retrospectively analyzed patients with acute ischemic stroke due to large vessel occlusion with successful mechanical thrombectomy (modified Treatment in Cerebral Infarction score 2b, 2c, or 3). PVT+ was defined as Tmax ≥10 seconds in the superior sagittal sinus or torcula. Favorable hypoperfusion intensity ratio was <0.4, and cerebral blood volume index was ≥0.8. We assessed their predictive value using logistic regression and receiver operating characteristic analysis. Among 119 patients (median age: 71 years, 59.7% female), 37 (30.3%) were PVT+. Favorable 90‐day modified Rankin Scale score (≤2) was achieved in 53.8%. PVT− had a sensitivity of 84.4%, outperforming cerebral blood volume index (75.0%) and hypoperfusion intensity ratio (54.7%). Combining PVT with CBV index or hypoperfusion intensity ratio improved predictive accuracy (area under the curve: 0.716–0.727; all P<0.05). Conclusions PVT is a superior predictor of 90‐day functional outcomes compared with cerebral blood volume index and hypoperfusion intensity ratio, emphasizing the role of venous outflow in collateral assessment and stroke prognosis. |
| format | Article |
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| language | English |
| publishDate | 2025-04-01 |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-764a550ec5d645f7944fc29272e46eaa2025-08-20T01:52:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114810.1161/JAHA.124.039924Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity RatioJanet Mei0Hamza Adel Salim1Dhairya A. Lakhani2Aneri Balar3Vaibhav Vagal4Manisha Koneru5Dylan Wolman6Risheng Xu7Victor Urrutia8Elisabeth Breese Marsh9Benjamin Pulli10Meisam Hoseinyazdi11Licia Luna12Francis Deng13Nathan Z. Hyson14Mona Shahriari15Adam A. Dmytriw16Adrien Guenego17Gregory W. Albers18Hanzhang Lu19Kambiz Nael20Argye E. Hillis21Rafael Llinas22Max Wintermark23Tobias D. Faizy24Jeremy J. Heit25Vivek Yedavalli26Department of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USARenaissance School of Medicine at Stony Brook University Stony Brook NY USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology Brown University Providence RI USADepartment of Neurosurgery, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Neurology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Neurology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Interventional Neuroradiology Stanford Medical Center Palo Alto CA USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USANeuroendovascular Program Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School Boston MA USADepartment of Diagnostic and Interventional Neuroradiology Erasme University Hospital Brussels BelgiumDepartment of Interventional Neuroradiology Stanford Medical Center Palo Alto CA USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Radiology & Biomedical Imaging University of California San Francisco CA USADepartment of Neurology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Neurology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USADepartment of Neuroradiology MD Anderson Medical Center Houston TX USADepartment of Radiology, Neuroendovascular Program University Medical Center Münster Münster GermanyDepartment of Interventional Neuroradiology Stanford Medical Center Palo Alto CA USADepartment of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USABackground Collateral status plays a crucial role in outcomes after acute ischemic stroke due to large vessel occlusion. Tissue‐level collaterals and venous outflow are key components following mechanical thrombectomy. This study evaluates the predictive performance of prolonged venous transit (PVT), cerebral blood volume index, and hypoperfusion intensity ratio in determining 90‐day functional outcomes. METHODS AND RESULTS We retrospectively analyzed patients with acute ischemic stroke due to large vessel occlusion with successful mechanical thrombectomy (modified Treatment in Cerebral Infarction score 2b, 2c, or 3). PVT+ was defined as Tmax ≥10 seconds in the superior sagittal sinus or torcula. Favorable hypoperfusion intensity ratio was <0.4, and cerebral blood volume index was ≥0.8. We assessed their predictive value using logistic regression and receiver operating characteristic analysis. Among 119 patients (median age: 71 years, 59.7% female), 37 (30.3%) were PVT+. Favorable 90‐day modified Rankin Scale score (≤2) was achieved in 53.8%. PVT− had a sensitivity of 84.4%, outperforming cerebral blood volume index (75.0%) and hypoperfusion intensity ratio (54.7%). Combining PVT with CBV index or hypoperfusion intensity ratio improved predictive accuracy (area under the curve: 0.716–0.727; all P<0.05). Conclusions PVT is a superior predictor of 90‐day functional outcomes compared with cerebral blood volume index and hypoperfusion intensity ratio, emphasizing the role of venous outflow in collateral assessment and stroke prognosis.https://www.ahajournals.org/doi/10.1161/JAHA.124.039924collateral assessmentCT perfusionlarge vessel occlusiontissue‐level collateralsvenous outflow |
| spellingShingle | Janet Mei Hamza Adel Salim Dhairya A. Lakhani Aneri Balar Vaibhav Vagal Manisha Koneru Dylan Wolman Risheng Xu Victor Urrutia Elisabeth Breese Marsh Benjamin Pulli Meisam Hoseinyazdi Licia Luna Francis Deng Nathan Z. Hyson Mona Shahriari Adam A. Dmytriw Adrien Guenego Gregory W. Albers Hanzhang Lu Kambiz Nael Argye E. Hillis Rafael Llinas Max Wintermark Tobias D. Faizy Jeremy J. Heit Vivek Yedavalli Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease collateral assessment CT perfusion large vessel occlusion tissue‐level collaterals venous outflow |
| title | Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio |
| title_full | Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio |
| title_fullStr | Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio |
| title_full_unstemmed | Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio |
| title_short | Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio |
| title_sort | prolonged venous transit as a superior predictor of functional outcomes in successfully reperfused large vessel occlusions comparative analysis with cerebral blood volume index and hypoperfusion intensity ratio |
| topic | collateral assessment CT perfusion large vessel occlusion tissue‐level collaterals venous outflow |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.039924 |
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