Abstract Background and aims Despite optimal medical management, recurrent ischemic stroke occurs in 10-20% of patients with large artery atherosclerosis within one year. This study evaluated whether cerebral venous hemodynamic parameters predict stroke recurrence. Methods This prospective longitudinal study enrolled 120 consecutive patients with recent ischemic stroke (within 7 days) attributed to large artery atherosclerosis (≥50% stenosis). Baseline evaluation included transcranial Doppler venous flow analysis, MR venography, NIHSS scoring, and collateral assessment. All patients received guideline-based secondary prevention. Patients were followed for 12 months; the primary endpoint was recurrent ischemic stroke. Results Recurrent stroke occurred in 21 patients (17.5%). Patients with recurrence had significantly lower baseline venous flow velocities (19.6±3.9 vs. 24.1±4.2 cm/s, p0.001) and higher venous PI values (1.52±0.21 vs. 1.35±0.17, p=0.002). Cox regression analysis, adjusting for age, traditional vascular risk factors, degree of arterial stenosis, and baseline NIHSS, demonstrated that reduced venous outflow velocity remained independently associated with stroke recurrence (HR 2.9, 95% CI 1.5–5.6, p=0.001). Conclusions Cerebral venous hemodynamic impairment independently predicts recurrent ischemic stroke in large artery atherosclerosis beyond conventional risk factors. Incorporating venous flow assessment may enhance risk prediction and enable more targeted secondary prevention strategies. Conflict of interest Fayzullo Mallayev: nothing to disclose
Mallaev et al. (Fri,) studied this question.
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