AUTHOR=Kim Dae-Hyun , Lee Yoon-Kyung , Cha Jae-Kwan 

TITLE=Prominent FLAIR Vascular Hyperintensity Is a Predictor of Unfavorable Outcomes in Non-thrombolysed Ischemic Stroke Patients With Mild Symptoms and Large Artery Occlusion

JOURNAL=Frontiers in Neurology

VOLUME=Volume 10 - 2019

YEAR=2019

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00722

DOI=10.3389/fneur.2019.00722

ISSN=1664-2295

ABSTRACT=Background and objective: The aim was to evaluate the clinical significance of prominent fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) on the prognosis of mild acute ischemic stroke with middle cerebral artery (MCA) occlusion. Methods: From our prospective stroke database, we identified consecutive stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores of ≤5 and MCA occlusion on MR angiography within 24 hours of stroke onset. Prominent distal FVH was defined as an extension to more than one-third of the MCA territory. We compared clinical outcomes between prominent and non-prominent FVH groups in patients who had and had not received reperfusion therapy. Results: Of 112 participants (43 women, mean age, 63.4 ± 14.4 years), prominent FVH was identified in 80 (71.4%) and was associated with FVH-diffusion weighted imaging mismatch. In 74 patients who had not received reperfusion therapy, the prominent FVH group had a more unfavorable outcome (a modified Rankin Scale score higher than 1) at 3 months than the non-prominent FVH group (44.4% vs 15.0%, P= 0.029). In multivariate analysis, initial higher NIHSS score (OR=1.54; 95% CI, 1.06-2.24; P=0.025), proximal MCA occlusion (OR=8.94; 95% CI, 1.82-44.3; P=0.007) and prominent FVH (odds ratio= 5.82; 95% confidence interval [CI], 1.25-27.2; P=0.025), were independently associated with an unfavorable outcome. There was no association between prominent FVH and the clinical outcome in the reperfusion therapy group. Conclusions: For acute stroke patients with mild symptoms and MCA occlusion who do not receive reperfusion therapy, prominent FVH and proximal MCA occlusion may be independent predictors of an unfavorable outcome.