Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China (Z.Z., J.X.).
The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Australia (Z.Z., S.Y., C.D., A.M., T.T.-Y., C.C., X.W., X.C., J.C., C.S.A.).
Stroke. 2020 Jul;51(7):2240-2243. doi: 10.1161/STROKEAHA.119.028550. Epub 2020 Jun 17.
To determine factors associated with fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on magnetic resonance imaging and their prognostic significance in thrombolysis-treated patients with acute ischemic stroke from the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) trial alteplase-dose arm.
Patients with acute ischemic stroke (N=293) with brain magnetic resonance imaging (FLAIR and diffusion-weighted imaging sequences) scanned <4.5 hours of symptom onset were assessed for location and extent (score) of FLAIR-HAs, infarct volume, large vessel occlusion (LVO), and other ischemic signs. Logistic regression models were used to determine predictors of FLAIR-HAs and the association of FLAIR-HAs with 90-day outcomes: favorable functional outcome (primary; modified Rankin Scale scores, 0-1), other modified Rankin Scale scores, and intracerebral hemorrhage.
Prior atrial fibrillation, LVO, large infarct volume, and anterior circulation infarction were independently associated with FLAIR-HAs. The rate of modified Rankin Scale scores 0 to 1 was numerically lower in patients with FLAIR-HAs versus without (69/152 [45.4%] versus 75/131 [57.3%]), as was the subset of LVO (37/93 [39.8%] versus 9/16 [56.3%]), but not in those without LVO (25/36 [69.4%] versus 60/106 [56.6%]). After adjustment for covariables, FLAIR-HAs were independently associated with increased primary outcome (adjusted odds ratio [95% CI]: overall 4.14 [1.63-10.50]; with LVO 4.92 [0.87-27.86]; no LVO 6.16 [1.57-24.14]) despite an increased risk of hemorrhagic infarct (4.77 [1.12-20.26]).
FLAIR-HAs are more frequent in acute ischemic stroke with cardioembolic features and indicate potential for a favorable prognosis in thrombolysis-treated patients possibly mediated by LVO. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01422616.
本研究旨在确定磁共振成像上液体衰减反转恢复（FLAIR）高信号血管（FLAIR-HA）与溶栓治疗急性缺血性脑卒中患者预后的相关性，并分析其在 ENCHANTED（强化高血压控制与溶栓治疗研究）试验中阿替普酶剂量组的意义。
对 293 例起病 4.5 小时内进行脑部磁共振成像（FLAIR 和弥散加权成像序列）扫描的急性缺血性脑卒中患者进行评估，包括 FLAIR-HA 的位置和程度（评分）、梗死体积、大血管闭塞（LVO）和其他缺血性征象。采用 Logistic 回归模型确定 FLAIR-HA 的预测因素，并分析 FLAIR-HA 与 90 天转归的相关性：良好的功能结局（主要结局；改良 Rankin 量表评分 0-1）、其他改良 Rankin 量表评分和颅内出血。
先前的心房颤动、LVO、大梗死体积和前循环梗死与 FLAIR-HA 独立相关。与无 FLAIR-HA 的患者相比，有 FLAIR-HA 的患者改良 Rankin 量表评分 0-1 的比例（69/152 [45.4%] 比 75/131 [57.3%]）以及 LVO 亚组（37/93 [39.8%] 比 9/16 [56.3%]）较低，但无 LVO 的患者中无明显差异（25/36 [69.4%] 比 60/106 [56.6%]）。在校正协变量后，FLAIR-HA 与主要结局的增加独立相关（调整后比值比[95%CI]：总体 4.14[1.63-10.50]；有 LVO 4.92[0.87-27.86]；无 LVO 6.16[1.57-24.14]），尽管出血性梗死的风险增加（4.77[1.12-20.26]）。
伴有心源性栓塞特征的急性缺血性脑卒中患者中 FLAIR-HA 更为常见，并且可能与 LVO 相关，提示溶栓治疗患者预后良好。
