{"doi":"10.1111/jon.70091","title":"Prolonged Venous Transit Is Associated With Unfavorable Outcomes in Anterior Circulation Distal Medium Vessel Stroke","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.","journal":"Journal of Neuroimaging","year":2025,"id":550941,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9114,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":356566,"name":"Dhairya A. 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Llinás","orcid":"0000-0002-9161-2699","position":16,"is_corresponding":false},{"id":2002,"name":"Kambiz Nael","orcid":"0000-0002-4194-9488","position":17,"is_corresponding":false},{"id":1446461,"name":"Max Wintermark","orcid":"0000-0003-1001-5591","position":18,"is_corresponding":false},{"id":545438,"name":"Jeremy J. Heit","orcid":"0000-0003-1055-8000","position":19,"is_corresponding":false},{"id":788821,"name":"Tobias D. 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