Factors Associated With Prolonged Venous Transit in Large Vessel Occlusion Acute Ischemic Strokes

Background and purpose: Prolonged venous transit (PVT), derived from computed tomography perfusion (CTP) time-to-maximum (T_max) maps, reflects compromised venous outflow (VO) in acute ischemic stroke due to large vessel occlusion (AIS-LVO). Poor VO is associated with worse clinical outcomes, but pre-treatment markers predictive of PVT are not well described.

Methods: We conducted a retrospective analysis of 189 patients with anterior circulation AIS-LVO who underwent baseline CT evaluation, including non-contrast CT, CT angiography, and CTP. PVT was assessed on T_max maps; PVT+ was defined as T_max ≥ 10 s within the posterior superior sagittal sinus or torcula. Baseline clinical data were collected. Multivariable logistic regression identified independent associations between pre-treatment markers and PVT.

Results: PVT+ was identified in 65 patients (34%). In multivariable analysis, higher admission National Institutes of Health Stroke Scale (NIHSS) scores (adjusted odds ratio [aOR], 1.05 per point; 95% confidence interval [CI], 1.01-1.11; P = 0.028) and male sex (aOR, 1.98; 95% CI, 1.03-3.89; P = 0.043) were independently associated with PVT+.

Conclusions: Higher admission NIHSS scores and male sex are independently associated with PVT in anterior circulation AIS-LVO, suggesting that readily available clinical markers may help identify patients with poor VO profiles.