Influential factors and clinical significance of fluid-attenuated inversion recovery vascular hyperintensities in transient ischemic attacks of carotid arterial system.

Abstract

Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is often observed in conjunction with acute ischemic stroke (AIS) of the carotid system. Despite its bearing on patient care outcomes, factors influencing FVH and its clinical significance in patients with transient ischemic attacks (TIAs) of the carotid arterial system have yet to be evaluated. Consecutive inpatients (N=154) diagnosed with TIAs of the carotid system in a 2-year period (2012-2014) were enrolled in our study. Each had undergone magnetic resonance imaging (MRI) within 72h of symptom onset, followed by intracranial and extracranial vascular imaging. We investigated the frequency and nature of factors associated with FVH, also examining its clinical significance in the 30-day prognosis of TIA. Of the 154 patients enrolled (male, 92; mean age 63.0±11.9), FVH was confirmed in 61 patients (39.6%). In logistic regression analysis, intracranial large-artery disease (LAD) (OR=2.39, 95% CI 1.16-4.92; p=0.018) and prior stroke (OR=3.33, 95% CI 1.48-7.51; p=0.004) emerged as factors independently associated with FVH positivity. Ultimately, 25 patients (16.2%) progressed to AIS within a 30-day follow-up period. Logistic regression analysis indicated that contralateral FVH positivity (OR=5.98, 95% CI 1.81-19.76; p=0.003), atrial fibrillation (OR=7.05, 95% CI 1.33-37.40; p=0.022), and extracranial LAD (OR=4.12, 95% CI 1.26-13.41; p=0.019) were independently associated with AIS during the 30-day follow-up of TIAs in these patients. Intracranial LAD and previous stroke are independently associated with FVH in patients experiencing carotid system TIAs. If present, FVH may predict an oncoming AIS in the 30days following a TIA.