Mei Janet, Salim Hamza Adel, Lakhani Dhairya A, Balar Aneri, Vagal Vaibhav, Koneru Manisha, Wolman Dylan, Xu Risheng, Urrutia Victor, Marsh Elisabeth Breese, Pulli Benjamin, Hoseinyazdi Meisam, Luna Licia, Deng Francis, Hyson Nathan Z, Shahriari Mona, Dmytriw Adam A, Guenego Adrien, Albers Gregory W, Lu Hanzhang, Nael Kambiz, Hillis Argye E, Llinas Rafael, Wintermark Max, Faizy Tobias D, Heit Jeremy J, Yedavalli Vivek
Department of Radiology, Division of Neuroradiology Johns Hopkins Medical Center Baltimore MD USA.
Department of Neuroradiology MD Anderson Medical Center Houston TX USA.
J Am Heart Assoc. 2025 Apr 15;14(8):e039924. doi: 10.1161/JAHA.124.039924. Epub 2025 Apr 7.
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.
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 ≥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 <0.05).
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.
在因大血管闭塞导致的急性缺血性卒中后，侧支循环状态对预后起着至关重要的作用。组织水平的侧支循环和静脉流出是机械取栓后的关键组成部分。本研究评估了延长静脉通过时间（PVT）、脑血容量指数和低灌注强度比值在确定90天功能结局方面的预测性能。
我们回顾性分析了因大血管闭塞且成功进行机械取栓（改良脑梗死治疗评分2b、2c或3）的急性缺血性卒中患者。PVT+定义为上矢状窦或窦汇处≥10秒。有利的低灌注强度比值<0.4，脑血容量指数≥0.8。我们使用逻辑回归和受试者工作特征分析评估了它们的预测价值。在119例患者（中位年龄：71岁，59.7%为女性）中，37例（30.3%）为PVT+。53.8%的患者90天改良Rankin量表评分良好（≤2）。PVT-的敏感性为84.4%，优于脑血容量指数（75.0%）和低灌注强度比值（54.7%）。将PVT与CBV指数或低灌注强度比值相结合可提高预测准确性（曲线下面积：0.716 - 0.727；均P<0.05）。
与脑血容量指数和低灌注强度比值相比，PVT是90天功能结局的更优预测指标，强调了静脉流出在侧支循环评估和卒中预后中的作用。
