Prolonged venous transit and clinical outcomes in anterior circulation large-vessel occlusion stroke with complete or near-complete reperfusion

Background: Prolonged venous transit (PVT), indicative of impaired venous outflow, is linked to poor outcomes in acute ischemic stroke due to large-vessel occlusion (AIS-LVO) treated with mechanical thrombectomy (MT). This study investigated the prognostic significance of PVT in AIS-LVO patients achieving near-complete or complete reperfusion (mTICI 2c or 3). Methods: Retrospective analysis of a prospective registry included AIS-LVO patients with anterior circulation occlusions, mTICI 2c or 3 after MT, and 90-day modified Rankin Scale (mRS) scores. PVT, defined as Tmax ≥ 10 s in the posterior superior sagittal sinus or torcula on pretreatment CT perfusion, was assessed. Outcomes were favorable recovery (mRS 0–2), excellent recovery (mRS 0–1), and 90-day mortality. Results: Among 81 patients, 25 (31%) were PVT + and 56 (69%) were PVT−. Baseline characteristics were similar. PVT + patients had higher discharge NIH Stroke Scale scores and worse 90-day mRS scores (median mRS, 4.00 vs. 1.00; P < 0.001). Multivariable analysis showed PVT + independently predicted lower odds of favorable (OR, 0.18; 95% CI, 0.04–0.65; P = 0.013) and excellent outcomes (OR, 0.12; 95% CI, 0.02–0.52; P = 0.008) and higher 90-day mortality (OR, 4.11; 95% CI, 1.08-17.0; P = 0.041). Conclusions: PVT is a strong negative prognostic marker in AIS-LVO patients with excellent reperfusion, associated with reduced functional recovery and increased 90-day mortality. PVT assessment may identify high-risk patients despite successful MT.