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FLAIR vascular hyperintensities and functional outcome in nonagenarians with anterior circulation large-vessel ischemic stroke treated with endovascular thrombectomy

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Abstract

Objectives

To establish whether imaging assessments of irreversibly injured ischemic core and potentially salvageable penumbral volumes and collateral circulation were associated with functional outcome in nonagenarians (90 years or older) undergoing endovascular thrombectomy (EVT).

Methods

Data from a prospectively maintained institutional registry of consecutive stroke patients treated with EVT from January 2012 to December 2018 were retrospectively analyzed. Functional outcome was evaluated with the modified Rankin scale (mRS) at 3 months. mRS score of 0–3 was defined as a good clinical outcome. Ischemic core and penumbral volumes were calculated using the RAPID software. Quantification of collateral circulation was performed using a fluid-attenuated inversion recovery vascular hyperintensity (FVH)–Alberta Stroke Program Early CT Score (ASPECTS) rating system.

Results

Among 85 patients (age, 92.4 ± 2.6 years; men, 30.6%) treated with EVT, good outcome (mRS 0–3) was achieved in 29 (34.1%) patients and 31 (36.5%) patients died at 90 days. The median estimated ischemic core volume was 15 mL (IQR, 7–27 mL). The median mismatch volume was 83 mL (IQR, 43–120 mL). The median FVH score was 4 (IQR, 3–4). FVH score was independently associated with good functional outcome (adjusted OR = 1.96 [95% CI, 1.16–3.32]; p = 0.01 per 1-point increase) and mortality (adjusted OR = 0.54 [95% CI, 0.34–0.85]; p = 0.007 per 1-point increase). Ischemic core and mismatch volumes were associated with neither good outcome nor mortality.

Conclusions

In nonagenarians with anterior circulation large-vessel ischemic stroke, good collaterals as measured by the FVH–ASPECTS rating system are independently associated with improved outcomes and may help select patients for reperfusion therapy in this frail population.

Key Points

• Endovascular thrombectomy can allow at least 1 in 3 patients older than 90 years of age to achieve good functional outcome (modified Rankin scale of 0–3) at 3 months.

• Functional outcome at 3 months is associated with pre-stroke status (number and severity of patients’ comorbidities).

• A higher FVH score (as reflected by higher FLAIR vascular hyperintensity [FVH]–Alberta Stroke Program Early CT Score [ASPECTS] values) is independently associated with better 3-month functional outcome and mortality in nonagenarians with anterior circulation ischemic stroke.

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Abbreviations

AIS:

Acute ischemic stroke

ASPECTS:

Alberta Stroke Program Early CT Score

CCI:

Charlson comorbidity index

EVT:

Endovascular thrombectomy

FOV:

Field of view

FVH:

Fluid-attenuated inversion recovery vascular hyperintensity

LVO:

Large-vessel occlusion

mRS:

Modified Rankin scale

mTICI:

Modified treatment in cerebral infarction

NIHSS:

National Institutes of Health Stroke Scale

sICH:

Symptomatic intracranial hemorrhage

tPA:

Tissue plasminogen activator

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France

    Imad Derraz, Raed Ahmed, Amel Benali, Federico Cagnazzo, Cyril Dargazanli, Gregory Gascou, Carlos Riquelme, Pierre-Henri Lefevre, Alain Bonafe & Vincent Costalat

  2. Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France

    Lucas Corti & Caroline Arquizan

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  1. Imad Derraz
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  2. Raed Ahmed
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Correspondence to Imad Derraz.

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The scientific guarantor of this publication is Vincent Costalat, MD, PhD.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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• Retrospective

• Cross-sectional study

• Performed at one institution

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Derraz, I., Ahmed, R., Benali, A. et al. FLAIR vascular hyperintensities and functional outcome in nonagenarians with anterior circulation large-vessel ischemic stroke treated with endovascular thrombectomy. Eur Radiol 31, 7406–7416 (2021). https://doi.org/10.1007/s00330-021-07866-1

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  • DOI: https://doi.org/10.1007/s00330-021-07866-1

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