ABSTRACT NUMBER: ESOC2026A1485 CEREBRAL VENOUS HEMODYNAMIC DISTURBANCES IN ACUTE ISCHEMIC STROKE WITH MAJOR ARTERY ATHEROSCLEROSIS

Abstract Background and aims Large artery atherosclerosis causes 15-20% of ischemic strokes, yet its impact on cerebral venous circulation remains poorly characterized. This study assessed cerebral venous hemodynamics in acute ischemic stroke patients with significant atherosclerotic disease and determined associations with stroke severity and infarct size. Methods We prospectively enrolled 120 consecutive patients with acute anterior circulation ischemic stroke caused by ≥50% stenosis of the internal carotid or middle cerebral artery. Assessments within 48 hours included neurological examination (NIHSS), brain CT/MRI with volumetric analysis, transcranial Doppler venous flow assessment, and MR venography. Venous flow velocity, pulsatility index (PI), and sinus diameter were compared with normative values. Results Patients demonstrated significantly reduced superior sagittal sinus flow velocity (22.4±4.8 vs. 28.6±3.2 cm/s, p<0.001) and increased venous PI (1.41±0.19 vs. 0.98±0.12, p<0.001). Reduced venous outflow strongly correlated with higher NIHSS scores (r=−0.48, p<0.001) and larger infarct volumes (r=−0.44, p<0.01). Patients with combined extracranial and intracranial atherosclerosis showed more pronounced venous impairment than those with isolated lesions (20.1±4.2 vs. 24.3±4.6 cm/s, p=0.02). Conclusions Cerebral venous outflow disturbances are prevalent in acute ischemic stroke related to major artery atherosclerosis and independently associate with greater neurological deficit and larger infarct size. Venous hemodynamic assessment may provide valuable additional prognostic information in acute stroke management. Conflict of interest Fayzullo Mallayev: nothing to disclose