Abstract W P50: FLAIR Vessel Hyperintensity In TIA and Minor Stroke Predicts Early Recurrent Stroke

Abstract

Objectives: FLAIR vessel hyperintensity (FVH) is frequently seen in patients with major acute ischemic stroke, but its significance in patients with transient ischemic attack (TIA) and minor stroke is not known. We sought to establish the prevalence of FVH in TIA and minor stroke and assess whether FVH predicts recurrent TIA or ischemic stroke. Methods: Consecutive patients from a prospective registry with high-risk TIA or minor stroke between 8/2012-7/2013 were analyzed based on these inclusion criteria: symptoms of unilateral weakness and/or speech deficit, NIHSS score ≤5, and completion of MRI within 48 hours of symptom onset. We excluded patients with isolated brainstem or cerebellar syndromes. MRI scans were reviewed by a single rater who was blinded to clinical data and used examples from published literature to score the presence of FVH and classify its location as proximal MCA, distal MCA, or PCA. After FVH rating, DWI and head and neck MRA were rated for presence of restricted diffusion and stenosis or occlusion. We employed univariable and multivariable statistics to identify independent predictors of FVH, and to examine the association between FVH and stroke recurrence. Results: Among 136 patients (mean age 69.5 ± 13.5 years; 43.4% female; 69.1% white; median NIHSS 1), 29 (21.3%) had FVH. The most common location was MCA (distal only 23; proximal only 1; distal/proximal: 3) with only 2 in the PCA. In multivariable analysis, the following variables were strongly associated with FVH: ipsilateral intracranial occlusion/stenosis (OR 13.7, 95% CI 4.8-39.2, p<0.001) and cardioembolic TOAST subtype (OR 7.4, CI 2.3-23.4, p=0.001). Neither DWI lesion nor ABCD2 score was associated with FVH. Patients with FVH were more likely to experience recurrent stroke or TIA within 90 days (17.2% vs. 1.9%; p=0.005). Conclusions: FVH is common in high-risk TIA and minor stroke patients, is associated with ipsilateral intracranial stenosis or occlusion, and strongly predicts recurrent TIA or stroke within 90 days. Since FVH did not correlate with DWI or ABCD2 scores, it should be considered in larger studies of clinical-imaging prediction tools of stroke risk after TIA and minor stroke.