Abstract TP48: Fluid-Attenuated Inversion Recovery Hyperintense Vessel Predicts Pre- and Post-Recanalization Infarct Lesion

Abstract

Background and Purpose: In patients with emergent large vessel occlusion (ELVO), fluid-attenuated inversion recovery (FLAIR) hyperintense vessel (FHV) has been linked to cerebral hypoperfusion. However, the association between FHV and infarction lesion after successful recanalization by endovascular thrombectomy (ET) remains unknown. In this study, we investigated the relationship baseline FHV and baseline or post-ET diffusion weighted imaging (DWI) positive lesions. Methods: From April 2012 to August 2016, fifty-nine patients were received ET for ELVO of the anterior circulation. We included twenty-five patients of them who obtained successful (Thrombolysis In Cerebral Infarction score 2b/3) recanalization of ICA or M1 occlusion. All patients had DWI before and after ET and FLAIR before ET. Infarct lesions and FHV were evaluated in seven cortical lesions which divided according to cortical area of Alberta Stroke Program Early CT (ASPECT) scoring (I, M1-M6). The association between baseline or post-ET DWI positive and baseline FHV was analyzed in each one hundred seventy-five lesions. Results: DWI positive lesions were present in 65/171 (37%) and 108/175 (62%) lesions on baseline and post-ET DWI, respectively. FHV was present in 89/175 (51%) lesions on baseline FLAIR. Baseline DWI positive lesion was significantly higher at FHV positive lesion than FHV negative lesion (FHV (+) vs. FHV (-): 56% vs. 17%, p<0.0001). In one-hundred ten baseline DWI negative lesions, FHV positive lesion was likely to become post-ET DWI positive than FHV negative lesion (FHV (+) vs. FHV (-): 51% vs. 32%, p=0.052). In patients who obtained successful recanalization within 6 hours from onset, post-ET DWI positive lesion was significantly higher at FHV positive lesion than FHV negative lesion (FHV (+) vs. FHV (-): 55% vs. 29%, p=0.0234). Conclusion: Baseline FHV positive lesions have already been infarcted before ET and likely to become infarction after successful recanalization compared to FHV negative lesion. Because FHV positive lesion became infarct despite early successful recanalization, FHV seemed to suggest severe hypoperfusion.