• 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, and Vivek S Yedavalli.
• Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
• J Neuroimaging. 2025 Jan 1; 35 (1): e70006e70006.

Background And PurposeProlonged venous transit (PVT), derived from computed tomography perfusion (CTP) time-to-maximum (Tmax) 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.MethodsWe 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 Tmax maps; PVT+ was defined as Tmax ≥ 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.ResultsPVT+ 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+.ConclusionsHigher 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.© 2025 American Society of Neuroimaging.

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