TY - JOUR
T1 - Thrombolysis outcomes in acute ischemic stroke by fluid-attenuated inversion recovery hyperintense arteries
AU - Zhou, Zien
AU - Yoshimura, Sohei
AU - Delcourt, Candice
AU - Lindley, Richard I.
AU - You, Shoujiang
AU - Malavera, Alejandra
AU - Torii-Yoshimura, Takako
AU - Carcel, Cheryl
AU - Wang, Xia
AU - Chen, Xiaoying
AU - Parsons, Mark W.
AU - Demchuk, Andrew M.
AU - Wardlaw, Joanna M.
AU - Mair, Grant
AU - Robinson, Thompson G.
AU - Chalmers, John
AU - Xu, Jianrong
AU - Anderson, Craig S.
PY - 2020/7
Y1 - 2020/7
N2 - BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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]). CONCLUSIONS: 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.
AB - BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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]). CONCLUSIONS: 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.
KW - Atrial fibrillation
KW - Infarction
KW - Magnetic resonance imaging
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85086886259&partnerID=8YFLogxK
U2 - 10.1161/strokeaha.119.028550
DO - 10.1161/strokeaha.119.028550
M3 - Article
C2 - 32568636
SN - 0039-2499
VL - 51
SP - 2240
EP - 2243
JO - Stroke
JF - Stroke
IS - 7
ER -