Abstract TP75: Distal Hyperintense Vessel Sign on FLAIR as a Predictor of Recurrent Stroke in Intracranial Arterial Stenosis

Abstract

Introduction: The distal hyperintensity vessel (DHV) on FLAIR images is a linear/serpentine shaped hyperintensity that is seen not infrequently in acute ischemic stroke or transient ischemic attack (TIA). Previous studies reported that DHV could predict large vessel occlusion or stenosis and correlate with outcome. The purpose of this study is to evaluate whether presence of DHV is associated with high risk of recurrent ischemic stroke in symptomatic intracranial atherosclerotic severe stenosis. Methods: We retrospectively reviewed patients who presented with ischemic stroke or TIA to a University-affiliated Comprehensive Stroke Center from 2010 to 2015. Patients with etiology due to 70-99% atherosclerosis stenosis of intracranial carotid artery or middle cerebral artery were enrolled. Patients with atrial fibrillation or other cardiac embolism, ipsilateral extracranial carotid artery > 50% stenosis, artery dissection, hypercoagulation state, Moyamoya or other non-atherosclerotic vasculopathy were excluded. FLAIR images were reviewed by two neuroradiologists and one vascular neurologist for the presence of DHV. A quantitative scoring system of maximum 7 based on ASPECTS distribution is applied to grade the extent of DHV. The primary measure is ischemic stroke in the territory of qualifying artery during follow up. Univariate and multivariate logistic regressions were used to identify predictors of recurrent ischemic stroke. Results: Out of 106 patients enrolled, 53 (50%) were found to have DHV (median score of 3.03 ± 1.47). There were more non-whites in DHV group than in non-DHV group (p=0.0314). During follow up, 17 (32%) patients in DHV group had recurrent ischemic stroke compared to 6 (11%) patients in non-DHV group (p=0.0087). The presence of DHV was the only factor associated with recurrent ischemic stroke with OR of 3.074 (95% CI 1.079 - 8.761, p=0.036) by multivariate logistic regression. There is a tendency of high risk of recurrent ischemic stroke for high DHV score with Pearson Correlation R value of 0.7. Conclusions: The presence of DHV is associated with higher risk of recurrent ischemic stroke in symptomatic intracranial atherosclerotic severe stenosis. Confirmation of this finding in large prospective studies is needed.