Background: To investigate the value of fluid-attenuated inversion recovery (FLAIR) Vascular Hyperintensity (FVH) in predicting early neurological deterioration (END) and short-term prognosis in acute ischemic stroke (AIS) patients who beyond the time window for recanalization therapy.
Methods: We retrospectively analyzed the AIS patients from 24 to 72 hours after symptom onset, who received dual antiplatelet therapy (DAPT). The patients were divided into the END and no early neurological deterioration (NEND) group according to the change of the National Institutes of Health Stroke Scale (NIHSS) score. The patients were also divided into the favorable and unfavorable prognosis group according to the 90 day modified Rankin Scale (mRS). The Alberta Stroke Program Early CT Score (ASPECTS) was used to assess the scope of infarction on DWI; the modified ASPECTS was used to assess the presence of FVH on FLAIR and multiple hypointense vessels (MHV) on SWI. We performed binary stepwise regression analysis with END and short-term prognosis as dependent variables to evaluate the odds ratio (OR) and its 95% confidence interval (CI) of primary outcomes. Next, we sequentially excluded nonsignificant variables from the last model to determine the risk factors of END.
Results: Two-hundred sixty-seven patients were included in this study. The median NIHSS score at admission was 6 [interquartile range (IQR) 5, 9], the median DWI-ASPECTS at admission was 8 (IQR 6, 9), the median FVH score was 7 (IQR 3, 7), and the median MHV-ASPECTS was 8 (IQR 6, 8). The NIHSS score at admission was higher in the END group. The MHV-ASPECTS, DWI-ASPECTS, and FVH-ASPECTS were lower in the END group. Binary stepwise regression analysis showed that the FVHASPECTS (OR =0.39, 95% CI: 0.174-0.872) and vascular stenosis/occlusion (OR =0.015, 95% CI: 0.000- 0.943) were independent risk factors of END.
Conclusions: For AIS patients beyond the time window for recanalization therapy who are receiving DAPT, a low FVH-ASPECTS is associated with a higher risk of END. In patients with vascular occlusion/ stenosis, FVH may be used as a predictor of END and an unfavorable 90-day prognosis in patients beyond the time window for recanalization therapy who are receiving DAPT.
Keywords: Acute ischemic stroke (AIS); early neurological deterioration (END); fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH).