Prolonged Venous Transit Is Associated With Unfavorable Outcomes in Anterior Circulation Distal Medium Vessel Stroke

IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY
Hamza Adel Salim, Dhairya A. Lakhani, Aneri Balar, Mona Shahriari, Aakanksha Sriwastawa, Andrew Cho, Adam A. Dmytriw, Adrien Guenego, 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

Distal medium-vessel occlusion (DMVO) strokes represent a significant proportion of acute ischemic stroke cases, yet optimal management remains unclear. Prolonged venous transit (PVT), a marker of poor venous outflow, has been associated with worse outcomes in large-vessel occlusion strokes, but its role in DMVO is unknown.

Methods

In a retrospective study, consecutive patients with anterior-circulation DMVO, defined as occlusions in the M2–M4 segments of the middle cerebral artery or the anterior cerebral artery. PVT status was determined on pretreatment time-to-maximum perfusion maps by identifying ≥10-s delays in either the posterior superior sagittal sinus or the torcula. Baseline characteristics, imaging findings, and interventions were collected. The primary outcome was a 90-day modified Rankin Scale (mRS) score of 0–2.

Results

Among 77 patients (median age 70 years, 56% female), 18 (23%) had PVT. Median admission National Institutes of Health Stroke Scale scores were 11 (interquartile range, 7–15), and intravenous thrombolysis was administered to 35% of patients. Patients with PVT+ were less likely to achieve mRS 0–2 at 90 days (adjusted odds ratio, 0.14; 95% confidence interval, 0.02–0.85; p = 0.046). There were no significant differences in rates of hemorrhagic transformation or mortality.

Conclusions

PVT is independently associated with unfavorable functional outcomes in anterior-circulation DMVO. These findings suggest PVT may serve as a prognostic indicator and could inform treatment decisions in this challenging stroke subtype.

延长静脉转运与前循环远端中血管卒中的不良结局相关
背景和目的远端中血管闭塞(DMVO)卒中在急性缺血性卒中病例中占很大比例,但最佳治疗方法尚不清楚。静脉输送延长(PVT)是静脉流出不良的标志,与大血管闭塞性卒中的不良预后相关,但其在DMVO中的作用尚不清楚。方法回顾性研究连续的前循环DMVO患者,定义为大脑中动脉或大脑前动脉M2-M4段闭塞。通过识别后上矢状窦或小环的延迟≥10秒,在预处理时间到最大灌注图上确定PVT状态。收集基线特征、影像学表现和干预措施。主要观察指标为90天修正兰金量表(mRS)评分0-2分。结果77例患者中(中位年龄70岁,56%为女性),18例(23%)患有ppt,入院时美国国立卫生研究院卒中量表中位评分为11分(四分位数范围为7-15分),35%的患者接受静脉溶栓治疗。PVT+患者在90天达到mRS 0-2的可能性较小(校正优势比为0.14;95%可信区间为0.02-0.85;p = 0.046)。在出血性转化率和死亡率方面没有显著差异。结论PVT与前循环DMVO的不良功能结局独立相关。这些发现表明,PVT可能作为预后指标,可以为这种具有挑战性的卒中亚型的治疗决策提供信息。
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来源期刊
Journal of Neuroimaging
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!
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