Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy

• Published in: Diagnostic and interventional imaging Vol. 104; no. 7-8; pp. 337 - 342
• Main Authors: Bani-Sadr, Alexandre, Escande, Raphaël, Mechtouff, Laura, Pavie, Dylan, Hermier, Marc, Derex, Laurent, Choc, Tae-Hee, Eker, Omer F., Nighoghossian, Norbert, Berthezène, Yves
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.07.2023; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Brain Ischemia - complications; Brain Ischemia - diagnostic imaging; Brain Ischemia - therapy; Collateral circulation; Female; Humans; Hypertension - complications; Ischemic Stroke - complications; Life Sciences; Magnetic resonance imaging; Male; Middle Aged; Radiology; Retrospective Studies; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - therapy; Thrombectomy; Thrombectomy - adverse effects; Thrombectomy - methods; Treatment Outcome; Young Adult; NIHSS; Treatment outcome; Stroke; OR; CI; MT; AIS; IQR; mRs; mTICI; Collateral circulation; Thrombectomy; Magnetic resonance imaging; VHF; DWI; FLAIR; Diffusion-weighted imaging; modified thrombolysis in cerebral infarction; Vascular hyperintensities on FLAIR images; National Institutional of Health Stroke Scale; Fluid-attenuated inversion recovery; Confidence interval; modified Rankin scale; Acute ischemic stroke; Mechanical thrombectomy; Interquartile range; Odds ratio
• ISSN: 2211-5684; 2211-5684
• DOI: 10.1016/j.diii.2023.02.005

•The degree of collateral circulation is a critical prognostic factor in patients with acute ischemic stroke because it promotes a higher rate of effective recanalization.•The prognostic value of vascular hyperintensities on fluid-attenuated inversion recovery (FLAIR) MR images in patients achieving effective recanalization after mechanical thrombectomy is not well known.•Poorly extended vascular hyperintensities on FLAIR images at admission MRI are associated with a poor functional outcome at three months despite successful recanalization using mechanical thrombectomy. The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy. Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization. A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0–93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55–12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87–1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04–1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07–4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08–0.61; P = 0.004). Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.