Kim Dae-Hyun, Lee Yoon-Kyung, Cha Jae-Kwan
Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, South Korea.
Department of Neurology, College of Medicine, Dong-A University, Busan, South Korea.
Front Neurol. 2019 Jul 2;10:722. doi: 10.3389/fneur.2019.00722. eCollection 2019.
The aim was to evaluate the clinical significance of prominent fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) on the prognosis of mild acute ischemic stroke with middle cerebral artery (MCA) occlusion. We recruited consecutive stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 and MCA occlusion on magnetic resonance angiography within 24 h of stroke onset. Prominent distal FVH was defined as an extension to more than one-third of the MCA territory. We compared clinical outcomes between prominent and non-prominent FVH groups in patients who had and had not received reperfusion therapy. Of 112 participants [43 women; median age, 67 years [Interquartile range, 54-79]], prominent FVH was identified in 80 (71.4%). For 75 patients who had not received reperfusion therapy, the prominent FVH group had a more unfavorable outcome (modified Rankin Scale score >1) at 3 months than the non-prominent FVH group (44.4 vs. 15.0%, = 0.029). In multivariate analysis, a higher NIHSS score [odd ratio [OR] = 1.67; 95% confidence interval [CI], 1.16-2.41; = 0.006], proximal MCA occlusion [OR = 7.31; 95% CI, 1.68-31.9; = 0.008], and prominent FVH [OR = 5.49; 95% CI, 1.29-23.4; = 0.021], were independently associated with an unfavorable outcome. There was no association between prominent FVH and the clinical outcome in the reperfusion therapy group. For acute stroke patients with mild symptoms and MCA occlusion who do not receive reperfusion therapy, prominent FVH and proximal MCA occlusion may be independent predictors of an unfavorable outcome.
目的是评估明显的液体衰减反转恢复（FLAIR）血管高信号（FVH）对大脑中动脉（MCA）闭塞的轻度急性缺血性卒中预后的临床意义。我们连续招募了卒中发作24小时内初始美国国立卫生研究院卒中量表（NIHSS）评分≤5且磁共振血管造影显示MCA闭塞的卒中患者。明显的远端FVH定义为延伸至超过MCA区域的三分之一。我们比较了接受和未接受再灌注治疗的患者中明显FVH组和非明显FVH组的临床结局。在112名参与者中[43名女性；年龄中位数，67岁[四分位间距，54 - 79]]，80名（71.4%）发现有明显FVH。对于75名未接受再灌注治疗的患者，明显FVH组在3个月时的预后比非明显FVH组更差（改良Rankin量表评分>1）（44.4%对15.0%，P = 0.029）。在多变量分析中，较高的NIHSS评分[比值比（OR）= 1.67；95%置信区间（CI），1.16 - 2.41；P = 0.006]、近端MCA闭塞[OR = 7.31；95% CI，1.68 - 31.9；P = 0.008]和明显FVH[OR = 5.49；95% CI，1.29 - 23.4；P = 0.021]与不良预后独立相关。在再灌注治疗组中，明显FVH与临床结局无关联。对于未接受再灌注治疗的轻度症状且MCA闭塞的急性卒中患者，明显FVH和近端MCA闭塞可能是不良预后的独立预测因素。
