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FLAIR vascular hyperintensity predicts early neurological deterioration in patients with acute ischemic stroke receiving endovascular thrombectomy

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Abstract

Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is frequently observed in patients with acute ischemic stroke (AIS). FVH is associated with functional outcome at 3 months in AIS patients receiving endovascular thrombectomy. In the present study, we assessed whether FVH predicted early neurological deterioration (END) and hemorrhagic transformation (HT) within 72 h in AIS patients receiving endovascular thrombectomy. We retrospectively analyzed 104 patients with acute internal-carotid-artery or proximal middle-cerebral-artery occlusion within 16 h after symptom onset. Before thrombectomy, all patients underwent brain magnetic resonance imaging. END was defined as an increase of 4 points or more from baseline National Institutes of Health Stroke Scale (NIHSS) during 72 h following onset. HT was assessed by brain computed tomography. Statistical analyses were performed to predict END and HT. The proportion of high FVH score, high American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grade in non-END group was higher than that in END group (p < 0.001, p < 0.001, respectively). FVH score was positively correlated with ASITN/SIR grade (r = 0.461, p < 0.001). FVH score was a predictor factor for END (adjusted OR, 13.552; 95% CI, 2.408–76.260; p = 0.003), while FVH score was not a predictor factor for HT. Furthermore, NIHSS at admission (adjusted OR, 1.112; 95% CI, 1.006–1.228; p = 0.038) and high-density lipoprotein cholesterol (adjusted OR, 18.865; 95% CI, 2.998–118.683; p = 0.002) were predictor factors for HT. To assess FVH score before thrombectomy might be useful for predicting END in AIS patients receiving endovascular thrombectomy.

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Data availability

All data supporting our results are available from the corresponding authors upon reasonable.

Code availability

NA.

Abbreviations

AIS:

Acute ischemic stroke

ASITN/SIR:

American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology

BP:

Blood pressure

CE:

Cardiac embolism

DSA:

Digital subtraction angiography

END:

Early neurological deterioration

FLAIR:

Fluid-attenuated inversion recovery

FVH:

FLAIR vascular hyperintensity

HbA1c:

Glycated hemoglobin A1C

HDL:

High-density lipoprotein cholesterol

HT:

Hemorrhagic transformation

LAA:

Large artery atherosclerosis

LDL:

Low-density lipoprotein cholesterol

LVO:

Large vessel occlusion

mTICI:

Modified Thrombolysis in Cerebral Ischemia

NIHSS:

National Institutes of Health Stroke Scale

ODC:

Other determined cause

TOAST:

Trial of Org 10172 in Acute Stroke Treatment

UND:

Undetermined cause

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Author notes

  1. Ni-Hong Chen, Yi-Ming Zhang and Fu-Ping Jiang contributed equally

Authors and Affiliations

  1. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, Jiangsu Province, 210006, People’s Republic of China

    Ni-Hong Chen, Yi-Ming Zhang, Shen Liu, Hong-Dong Zhao, Jian-Kang Hou, Teng Jiang, Jian-Quan Shi, Jun-Shan Zhou & Ying-Dong Zhang

  2. Department of Geriatrics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, People’s Republic of China

    Fu-Ping Jiang

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Contributions

Data curation: Ni-Hong Chen, Yi-Ming Zhang, and Fu-Ping Jiang. Formal analysis: Teng Jiang and Shen Liu. Investigation: Hong-Dong Zhao and Jian-Kang Hou. Methodology: Shen Liu, Hong-Dong Zhao, Jian-Kang Hou, and Teng Jiang. Writing—original draft: Ni-Hong Chen. Writing—review and editing: Jian-Quan Shi, Jun-Shan Zhou, and Ying-Dong Zhang.

Corresponding authors

Correspondence to Jian-Quan Shi, Jun-Shan Zhou or Ying-Dong Zhang.

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The study protocol was approved by the ethics committee of Nanjing First Hospital, Nanjing Medical University and followed the tenets of the Declaration of Helsinki.

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All patients or their legally authorized representatives gave their written consent to participate in the study.

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Chen, NH., Zhang, YM., Jiang, FP. et al. FLAIR vascular hyperintensity predicts early neurological deterioration in patients with acute ischemic stroke receiving endovascular thrombectomy. Neurol Sci 43, 3747–3757 (2022). https://doi.org/10.1007/s10072-021-05853-4

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