大血管闭塞急性缺血性卒中患者静脉通过时间延长的相关因素

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

作者信息

Salim Hamza Adel, Lakhani Dhairya A, Balar Aneri B, Mei Janet, Luna Licia, Shahriari Mona, Hyson Nathan Z, Deng Francis, Dmytriw Adam A, Guenego Adrien, Urrutia Victor C, Marsh Elisabeth B, Lu Hanzhang, Xu Risheng, Leigh Rich, Shah Gaurang, Wen Sijin, Albers Gregory W, Hillis Argye E, Llinas Rafael, Nael Kambiz, Wintermark Max, Heit Jeremy J, Faizy Tobias D, Yedavalli Vivek S

机构信息

Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.

Department of Neuroradiology, MD Anderson Medical Center, Houston, Texas, USA.

出版信息

J Neuroimaging. 2025 Jan-Feb;35(1):e70006. doi: 10.1111/jon.70006.

DOI:10.1111/jon.70006

PMID:39809719

Abstract

BACKGROUND AND PURPOSE

Prolonged venous transit (PVT), derived from computed tomography perfusion (CTP) time-to-maximum (T) 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 maps; PVT+ was defined as T ≥ 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.

摘要

背景与目的

源自计算机断层扫描灌注（CTP）时间-峰值（T）图的延长静脉通过时间（PVT）反映了急性缺血性卒中因大血管闭塞（AIS-LVO）导致的静脉流出道（VO）受损。静脉流出道不佳与更差的临床结局相关，但预测PVT的治疗前标志物尚未得到充分描述。

方法

我们对189例接受前循环AIS-LVO的患者进行了回顾性分析，这些患者接受了包括非增强CT、CT血管造影和CTP在内的基线CT评估。在T图上评估PVT；PVT+定义为上矢状窦后部或窦汇处T≥10秒。收集基线临床数据。多变量逻辑回归确定了治疗前标志物与PVT之间的独立关联。

结果

65例患者（34%）被确定为PVT+。在多变量分析中，较高的入院美国国立卫生研究院卒中量表（NIHSS）评分（调整优势比[aOR]，每分1.05；95%置信区间[CI]，1.01-1.11；P = 0.028）和男性（aOR，1.98；95%CI，1.03-3.89；P = 0.043）与PVT+独立相关。