Prolonged venous transit - where venous outflow meets financial outflow: a cost analysis.

Purpose: Healthcare costs in large vessel occlusion acute ischemic stroke (AIS-LVO) patients vary widely despite achieving successful reperfusion. Prolonged venous transit (PVT+) is a new marker of poor venous outflow on pretreatment perfusion imaging associated with various patient outcomes. We aim to explore the relationship between PVT + and acute care cost estimates for AIS-LVO.

Methods: Adult AIS-LVO patients achieving successful reperfusion with thrombectomy at three centers in the United States were retrospectively reviewed. Cost estimates were derived from national averages for services in the Centers for Medicare and Medicaid Services data (2025). The primary outcome was total cost estimates for acute intervention, imaging, and post-treatment inpatient care until discharge. Estimates were compared between PVT + and PVT- cohorts.

Results: In 109 included patients, the median age was 71 years (IQR 62-80). The cost estimates for total acute stroke care were significantly greater by $11787 in PVT + patients (median $36601 [IQR $24814-$72944] than PVT- patients (median $24814 [IQR $16956-$48388], p = 0.03). Cost of post-treatment care was significantly greater in PVT + patients than PVT- patients (p = 0.03).

Conclusion: PVT + demonstrates potential as a useful, versatile pretreatment biomarker, in conjunction with other clinical data, to anticipate in-hospital resources and costs associated with acute stroke care.