Fluid-Attenuated Inversion Recovery Vascular Hyperintensity An Early Predictor of Clinical Outcome in Proximal Middle Cerebral Artery Occlusion

Background: Few data are available on the relationship between fluid-attenuated inversion recovery vascular hyperintensities and proximal middle cerebral artery occlusion prognosis. Objectives: To assess a fluid-attenuated inversion recovery vascular hyperintensities score (FVHS) and explore its relationship with recanalization status and clinical outcomes after intravenous thrombolysis. Design: Retrospective study. Setting: Stroke unit in a university hospital. Patients: Consecutive patients with proximal middle cerebral artery occlusion, thrombolysed within 6 hours, were selected from our prospective database. The FVHS (range, 0-10; divided into low, medium, and high thirds) was quantified on the magnetic resonance image obtained at admission. Recanalization rates, infarction size (Alberta Stroke Program Early CT Score applied to diffusion-weighted imaging [ASPECTS-DWI]), and 3-month functional outcomes (modified Rankin Scale score) were determined. Poor outcomes and large infarctions were defined as a modified Rankin Scale score higher than 2 and an ASPECTS-DWI score of 5 or lower, respectively. Main Outcome Measures: Interaction among FVHS, recanalization status, and outcomes. Results: Thirty-four patients had a low FVHS (<= 4), 32 had a medium FVHS (5 or 6), and 39 had a high FVHS (>= 7). The rate of poor functional outcome (modified Rankin Scale score >2) was higher for the group with low FVHSs than those with medium FVHSs and high FVHSs (82.3% vs 43.7% and 43.5%, respectively; P < .001). The rate of 24-hour large infarctions(ASPECTS-DWI score <= 5) was higher for those with low FVHSs than those with medium and high FVHSs (88.2% vs 56.2% and 51.3%, respectively; P=.002). The recanalization rate was not associated with FVHS. Multivariate analysis retained low FVHS as an independent early predictor of poor clinical outcome (odds ratio=9.91; 95% CI, 2.01-48.93; P=.004) and large infarction (odds ratio=6.99; 95% CI, 1.78-27.46; P=.005). Low FVHS remained associated with poor outcomes regardless of recanalization status. Early recanalization in patients with a low FVHS decreased the poor functional outcome rate from 100% to 64.7% (P=.02). Conclusions: The FVHS is an early independent prognostic marker for patients with proximal middle cerebral artery occlusion. Synergy between FVHS and recanalization status appears to be a critical determinant of final outcomes, supporting intensive reperfusion treatment for patients with a low FVHS.