17 Jun 20. Featured Paper

Thrombolysis outcomes in acute ischemic stroke by fluid-attenuated inversion recovery hyperintense arteries.

Link to paper on AHA Journals, Stroke

Authors

Zien Zhou, Sohei Yoshimura, Candice Delcourt, Richard I. Lindley, Shoujiang You, Alejandra Malavera, Takako Torii-Yoshimura, Cheryl Carcel, Xia Wang, Xiaoying Chen, Mark W. Parsons, Andrew M. Demchuk, Joanna M. Wardlaw, Grant Mair, Thompson G. Robinson, John Chalmers, Jianrong Xu, Craig S. Anderson

Abstract

Background & purpose: To determine factors associated with fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on magnetic resonance imaging & their prognostic significance in thrombolysis-treated patients with acute ischemic stroke from the ENCHANTED (Enhanced Control of Hypertension & Thrombolysis Stroke Study) trial alteplase-dose arm.

Methods: Patients with acute ischemic stroke (N=293) with brain magnetic resonance imaging (FLAIR & diffusion-weighted imaging sequences) scanned <4.5 hours of symptom onset were assessed for location & extent (score) of FLAIR-HAs, infarct volume, large vessel occlusion (LVO), & other ischemic signs.

Logistic regression models were used to determine predictors of FLAIR-HAs & the association of FLAIR-HAs with 90-day outcomes: favorable functional outcome (primary; modified Rankin Scale scores, 0–1), other modified Rankin Scale scores, & intracerebral hemorrhage.

Results: Prior atrial fibrillation, LVO, large infarct volume, & anterior circulation infarction were independently associated with FLAIR-HAs.

The rate of modified Rankin Scale scores 0 to 1 was numerically lower in patients with FLAIR-HAs versus without (69/152 [45.4%] versus 75/131 [57.3%]), as was the subset of LVO (37/93 [39.8%] versus 9/16 [56.3%]), but not in those without LVO (25/36 [69.4%] versus 60/106 [56.6%]).

After adjustment for covariables, FLAIR-HAs were independently associated with increased primary outcome (adjusted odds ratio [95% CI]: overall 4.14 [1.63–10.50]; with LVO 4.92 [0.87–27.86]; no LVO 6.16 [1.57–24.14]) despite an increased risk of hemorrhagic infarct (4.77 [1.12–20.26]).

Conclusions: FLAIR-HAs are more frequent in acute ischemic stroke with cardioembolic features & indicate potential for a favorable prognosis in thrombolysis-treated patients possibly mediated by LVO.

Keywords

• Atrial fibrillation
• Infarction
• Magnetic resonance imaging
• Prognosis