Simplifying venous outflow: Prolonged venous transit as a novel qualitative marker correlating with acute stroke outcomes

Vivek S Yedavalli; Dhairya A Lakhani; Manisha Koneru; Aneri B Balar; Cynthia Greene; Meisam Hoseinyazdi; Mehreen Nabi; Hanzhang Lu; Risheng Xu; Licia Luna; Justin Caplan; Adam A Dmytriw; Adrien Guenego; Jeremy J Heit; Gregory W Albers; Max Wintermark; Victor Urrutia; Judy Huang; Kambiz Nael; Richard Leigh; Elisabeth B Marsh; Argye E Hillis; Rafael H Llinas

doi:10.1177/19714009241269475

Simplifying venous outflow: Prolonged venous transit as a novel qualitative marker correlating with acute stroke outcomes

Neuroradiol J. 2025 Feb;38(1):59-63. doi: 10.1177/19714009241269475. Epub 2024 Jul 27.

Authors

Vivek S Yedavalli¹, Dhairya A Lakhani, Manisha Koneru², Aneri B Balar¹, Cynthia Greene¹, Meisam Hoseinyazdi¹, Mehreen Nabi¹, Hanzhang Lu¹, Risheng Xu³, Licia Luna¹, Justin Caplan³, Adam A Dmytriw⁴, Adrien Guenego⁵, Jeremy J Heit⁶, Gregory W Albers⁷, Max Wintermark⁸, Victor Urrutia⁹, Judy Huang³, Kambiz Nael¹⁰, Richard Leigh⁹, Elisabeth B Marsh⁹, Argye E Hillis⁹, Rafael H Llinas⁹

Affiliations

¹ Department of Radiology and Radiological Sciences, Johns HopkinsSchool of Medicine, USA.
² Cooper Medical School of Rowan University, USA.
³ Department of Neurosurgery, Johns HopkinsSchool of Medicine, USA.
⁴ Department of Neuroradiology, Massachusetts General Hospital & Harvard Medical School, USA.
⁵ Department of Radiology, Université Libre De Bruxelles Hospital Erasme, USA.
⁶ Department of Radiology, Stanford UniversitySchool of Medicine, USA.
⁷ Department of Neurology, Stanford UniversitySchool of Medicine, USA.
⁸ Department of Radiology, University of Texas MD Anderson Center, USA.
⁹ Department of Neurology, Johns HopkinsSchool of Medicine, USA.
¹⁰ Department of Radiology, David Geffen School of Medicine at University of California - Los Angeles, USA.

PMID: 39067016
PMCID: PMC11571568 (available on 2025-07-27)
DOI: 10.1177/19714009241269475

Abstract

Background: Prolonged venous transit (PVT), defined as presence of time-to-maximum $\geq$ 10 s within the superior sagittal sinus (SSS) and/or torcula, is a novel, qualitatively assessed computed tomography perfusion surrogate parameter of venous outflow with potential utility in pretreatment acute ischemic stroke imaging for neuroprognostication. We aim to characterize the correlation between PVT and neurological functional outcomes in thrombectomy-treated patients.

Methods: A prospectively-collected database of large vessel occlusion acute ischemic stroke patients treated with thrombectomy was retrospectively analyzed. Spearman's rank correlation coefficient and point-biserial correlations were performed between PVT status (i.e., no region, either SSS or torcula, or both), 90-day modified Rankin score (mRS), mortality (mRS 6), and poor functional outcome (mRS 4-6 vs 0-3).

Results: Of 128 patients, correlation between PVT and 90-day mRS ( $ρ$ = 0.35, p < 0.0001), mortality (r = 0.26, p = 0.002), and poor functional outcome (r = 0.27, p = 0.002) were significant.

Conclusion: There is a modest, significant correlation between PVT and severity of neurological functional outcome. Consequently, PVT is an easily-ascertained, qualitative metric that may be useful as an adjunct for anticipating a patient's clinical course. Future analyses will determine the significance of incorporating PVT in clinical decision-making.

Keywords: Cerebrovascular circulation; computed tomography perfusion; neuroimaging; thrombectomy; treatment outcome; venous outflow.

MeSH terms

Aged
Aged, 80 and over
Cerebral Veins* / diagnostic imaging
Cerebral Veins* / physiopathology
Computed Tomography Angiography
Female
Humans
Ischemic Stroke* / diagnostic imaging
Ischemic Stroke* / physiopathology
Ischemic Stroke* / surgery
Male
Middle Aged
Retrospective Studies
Superior Sagittal Sinus* / diagnostic imaging
Superior Sagittal Sinus* / physiopathology
Thrombectomy
Treatment Outcome