{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:18:24Z","timestamp":1787894304629,"version":"build-2784847793"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged venous transit (PVT) on computed tomography perfusion (CTP) indicates impaired macroscopic venous outflow. The Brush Sign on susceptibility-weighted imaging (SWI) reflects microvascular venous congestion and the \u201cno-reflow\u201d phenomenon. We investigated whether pre-treatment PVT independently predicts the post-treatment Brush Sign in patients with anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) following successful mechanical thrombectomy (MT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed patients with anterior-circulation acute ischemic stroke due to large-vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] 2b\u20133) and underwent post-treatment magnetic resonance imaging (MRI). Pre-treatment PVT positivity (Tmax \u226510\u202fs in the superior sagittal sinus and\/or torcula) was evaluated on baseline CTP. The primary outcome was the presence of the Brush Sign on follow-up SWI. A multivariable logistic regression model evaluated the independent association between PVT and the Brush Sign, adjusting for age, admission National Institutes of Health Stroke Scale (NIHSS), intravenous thrombolysis, final infarct volume, mTICI score, and baseline Alberta Stroke Program Early CT Score (ASPECTS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 187 included patients, 29 (15.5%) demonstrated the Brush Sign. Pre-treatment PVT\u202f+\u202fwas significantly more prevalent in patients who developed the Brush Sign (48.3% vs. 27.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.02). In the adjusted multivariable model (N\u202f=\u202f130), PVT\u202f+\u202fremained a strong, independent predictor of the Brush Sign (OR 3.82, 95% CI 1.32\u201311.77, p\u202f=\u202f0.02). The association remained robust across sensitivity analyses accounting for MRI timing, complete reperfusion, occlusion segment, and suspected stroke etiology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pre-treatment PVT independently predicts the post-treatment Brush Sign in AIS-LVO patients despite successful macrovascular reperfusion. This finding links macroscopic venous congestion to downstream microvascular failure, highlighting PVT as an easily accessible imaging biomarker for anticipating the no-reflow phenotype.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1819534","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:34:15Z","timestamp":1787891655000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Baseline prolonged venous transit on CT perfusion predicts the post-treatment Brush Sign after successful reperfusion in acute ischemic stroke patients"],"prefix":"10.3389","volume":"17","author":[{"given":"Derek A.","family":"Tsang","sequence":"first","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Gad","sequence":"additional","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Cho","sequence":"additional","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Lalwani","sequence":"additional","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, MD Anderson Medical Center","place":["Houston, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhairya","family":"Lakhani","sequence":"additional","affiliation":[{"name":"WVU Rockefeller Neuroscience Institute","place":["Morgantown, WV, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Greene","sequence":"additional","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Koneru","sequence":"additional","affiliation":[{"name":"Cooper University Health Care","place":["Camden, NJ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women\u2019s Hospital, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Guenego","sequence":"additional","affiliation":[{"name":"Universite Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand","family":"Hui","sequence":"additional","affiliation":[{"name":"The Queen's Medical Center","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Heit","sequence":"additional","affiliation":[{"name":"Division of Neuroimaging and Neurointervention, Stanford University","place":["Stanford, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Faizy","sequence":"additional","affiliation":[{"name":"Universitatsklinikum Munster","place":["M\u00fcnster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Albers","sequence":"additional","affiliation":[{"name":"Division of Neuroimaging and Neurointervention, Stanford University","place":["Stanford, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanzhang","family":"Lu","sequence":"additional","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Aziz","sequence":"additional","affiliation":[{"name":"University of Cincinnati","place":["Cincinnati, OH, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aakanksha","family":"Sriwastaw","sequence":"additional","affiliation":[{"name":"University of Cincinnati","place":["Cincinnati, OH, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Yedavalli","sequence":"additional","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"651","DOI":"10.3389\/fneur.2017.00651","article-title":"Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: a review","volume":"8","author":"Malhotra","year":"2017","journal-title":"Front Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1177\/17474930241270524","article-title":"Pretreatment predictors of very poor clinical outcomes in medium vessel occlusion stroke patients treated with mechanical thrombectomy","volume":"19","author":"Yedavalli","year":"2024","journal-title":"Int J Stroke Off J Int Stroke 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reperfusion","volume":"67","author":"Salim","year":"2025","journal-title":"Neuroradiology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.3174\/ajnr.A8723","article-title":"The Brush Sign is associated with a more severe oxygen metabolic impairment of the ischemic penumbra: an MRI-based study in patients with acute stroke","volume":"46","author":"Criton","year":"2025","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2662","DOI":"10.1007\/s00330-025-12107-w","article-title":"Brush Sign on susceptibility-weighted imaging as a predictor of infarct growth in a single small subcortical infarction","volume":"36","author":"Yoshimura","year":"2025","journal-title":"Eur Radiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"625","DOI":"10.3785\/j.issn.1008-9292.2015.11.05","article-title":"Signifiance of Brush Sign on susceptibility-weighted imaging predicts hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke","volume":"44","author":"Xu","year":"2015","journal-title":"Zhejiang Xue Xue Bao Yi Xue Ban J Zhejiang Univ Med Sci"},{"key":"ref27","author":"Greene","year":"2025"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"573","DOI":"10.5281\/zenodo.16925770","article-title":"Prognostic significance of the prominent vein sign on susceptibility-weighted imaging for collateral circulation assessment in acute large vessel occlusion stroke: a systematic review and meta-analysis","volume":"58","author":"Krishnan","year":"2025","journal-title":"J Tianjin Univ Sci Technol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1161\/STROKEAHA.118.023457","article-title":"Highest lesion growth rates in patients with Hyperacute stroke: when time is brain particularly matters","volume":"50","author":"Broocks","year":"2019","journal-title":"Stroke"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s00062-024-01463-7","article-title":"High Hypoperfusion intensity ratio is independently associated with very poor outcomes in large ischemic Core stroke","volume":"35","author":"Yedavalli","year":"2025","journal-title":"Clin Neuroradiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e039924","DOI":"10.1161\/JAHA.124.039924","article-title":"Prolonged venous transit as a superior predictor of functional outcomes in successfully Reperfused large vessel occlusions: comparative analysis with cerebral blood volume index and Hypoperfusion intensity ratio","volume":"14","author":"Mei","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"110907","DOI":"10.1016\/j.jocn.2024.110907","article-title":"CT perfusion derived relative cerebral blood volume < 42% is negatively associated with poor functional outcomes at discharge in anterior circulation large vessel occlusion stroke","volume":"130","author":"Lakhani","year":"2024","journal-title":"J Clin Neurosci Off J Neurosurg Soc Austr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1161\/STROKEAHA.122.040540","article-title":"Hypoperfusion intensity ratio is correlated with the risk of parenchymal hematoma after endovascular stroke treatment","volume":"54","author":"Winkelmeier","year":"2023","journal-title":"Stroke"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1514924","DOI":"10.3389\/fneur.2024.1514924","article-title":"A new taxonomy of neuroprotective agents for stroke appropriate for the reperfusion era","volume":"15","author":"Bahr-Hosseini","year":"2024","journal-title":"Front Neurol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/S1474-4422(22)00519-1","article-title":"Thrombolysis for acute ischaemic stroke: current status and future perspectives","volume":"22","author":"Tsivgoulis","year":"2023","journal-title":"Lancet Neurol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1136\/jnnp-2020-324283","article-title":"The future of neuroprotection in stroke","volume":"92","author":"Chamorro","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"}],"container-title":["Frontiers in 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