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

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY Journal of Neuroimaging Pub Date : 2025-01-01 DOI:10.1111/jon.70006

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

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Abstract

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.

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大血管闭塞性急性缺血性脑卒中患者静脉流经时间延长的相关因素

背景和目的：通过计算机断层扫描灌注（CTP）时间到最大值（Tmax）图得出的延长静脉输送（PVT）反映了由于大血管闭塞（AIS-LVO）导致的急性缺血性卒中静脉流出（VO）受损。较差的VO与较差的临床结果相关，但治疗前预测PVT的标志物尚未得到很好的描述。方法：我们对189例前循环AIS-LVO患者进行了回顾性分析，这些患者接受了基线CT评估，包括非对比CT、CT血管造影和CTP。在Tmax图上评估PVT；PVT+定义为后上矢状窦或圆环内Tmax≥10 s。收集基线临床资料。多变量logistic回归发现治疗前标志物与PVT之间存在独立关联。结果：65例（34%）患者出现PVT+。在多变量分析中，高录取的美国国立卫生研究院卒中量表（NIHSS）得分(调整优势比[aOR]， 1.05 /分；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。结论：较高的入院NIHSS评分和男性与前循环AIS-LVO的PVT独立相关，表明易于获得的临床标志物可能有助于识别不良VO谱的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!