Prolonged Venous Transit Is Associated with Unfavorable Functional Outcomes in Large-Core Stroke

BACKGROUND AND PURPOSE: Large-core acute ischemic stroke caused by large-vessel occlusion (LVO) is associated with high rates of disability despite mechanical thrombectomy. Prolonged venous transit (PVT), a marker of impaired venous drainage on CTP, has emerged as a potential prognostic indicator, but its role in large-core acute ischemic stroke (AIS)-LVO remains unclear. We aimed to test the hypothesis that PVT is independently associated with unfavorable functional outcomes in patients with large-core AIS-LVO. MATERIALS AND METHODS: We conducted a retrospective cohort study using data from consecutive patients with AIS-LVO and large ischemic core volumes (ASPECTS <6 or relative CBF (rCBF)<30% volume ≥50 mL; per the SELECT-2 trial definition) between September 1, 2016, and September 2, 2024. PVT was assessed on pretreatment CTP based on qualitative time-to-maximum maps and was defined as time-to-maximum ≥10 seconds in the superior sagittal sinus or torcula. The primary outcome was unfavorable functional recovery at 90 days, defined as an mRS score of 4-6. RESULTS: = .032). CONCLUSIONS: PVT is independently associated with unfavorable outcomes in patients with large core AIS-LVO. These findings suggest that PVT may serve as a prognostic marker, warranting further investigation and validation in larger prospective studies to guide treatment decisions in this high-risk population.