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08.04.2022 | Neuro

FLAIR vascular hyperintensities predict functional outcome after endovascular thrombectomy in patients with large ischemic cores

verfasst von: Imad Derraz, Raed Ahmed, Isabelle Mourand, Cyril Dargazanli, Federico Cagnazzo, Nicolas Gaillard, Gregory Gascou, Carlos Riquelme, Pierre-Henri Lefevre, Alain Bonafe, Caroline Arquizan, Vincent Costalat

Erschienen in: European Radiology | Ausgabe 9/2022

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Abstract

Objectives

To establish whether collateral circulation was associated with functional outcome in stroke patients with large infarct size (Alberta Stroke Program Early CT Score [ASPECTS] ≤ 5) undergoing endovascular thrombectomy (EVT)

Methods

Consecutive patients with acute ischemic stroke due to large-vessel occlusion in the anterior circulation and an ASPECTS of ≤ 5 were analyzed. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)–ASPECTS rating system (score ranging from 0 [no FVH] to 7 [FVHs abutting all ASPECTS cortical areas]) by two independent neuroradiologists. Good functional outcome was defined by modified Rankin Scale (mRS) score of 0 to 3 at 3 months. We determined the association between FVH score and clinical outcome using multivariable regression analyses.

Results

A total of 139 patients (age, 63.1 ± 20.8 years; men, 51.8%) admitted between March 2012 and December 2017 were included. Good functional outcome (mRS 0–3) was observed in 65 (46.8%) patients, functional independence (mRS 0–2) was achieved in 43 (30.9%) patients, and 33 (23.7%) patients died at 90 days. The median FVH score was 4 (IQR, 3–5). FVH score was independently correlated with good outcome (adjusted OR = 1.41 [95% CI, 1.03–1.92]; p = 0.03 per 1-point increase).

Conclusions

In stroke patients with large-volume infarcts, good collaterals as measured by the FVH–ASPECTS rating system are associated with improved outcomes and may help select patients for reperfusion therapy.

Key Points

• Endovascular thrombectomy can allow almost 1 in 2 patients with large infarct cores to achieve good functional outcome (modified Rankin Scale [mRS] of 0–3) and 1 in 3 patients to regain functional independence (mRS 0–2) at 3 months.

• The extent of FVH score (as reflected by FLAIR vascular hyperintensity [FVH]–Alberta Stroke Program Early CT Score [ASPECTS] values) is associated with functional outcome at 3 months in this patient group.

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Titel: FLAIR vascular hyperintensities predict functional outcome after endovascular thrombectomy in patients with large ischemic cores
verfasst von: Imad Derraz
Raed Ahmed
Isabelle Mourand
Cyril Dargazanli
Federico Cagnazzo
Nicolas Gaillard
Gregory Gascou
Carlos Riquelme
Pierre-Henri Lefevre
Alain Bonafe
Caroline Arquizan
Vincent Costalat
Publikationsdatum: 08.04.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 9/2022
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08683-w

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FLAIR vascular hyperintensities predict functional outcome after endovascular thrombectomy in patients with large ischemic cores