European Radiology: This imaging manifestation of EVT in ischemic stroke patients is related to the evaluation of patient prognosis!

Currently, acute ischemic stroke (AIS) is a major global health burden
due to its high disability and mortality rates.
Endovascular thrombectomy (EVT) has become one of the important quality modalities for
AIS patients.
However, even if recanalization is successfully achieved, more than 50% of patients do not achieve good treatment results
within 3 months.
Therefore, there is an urgent need for a simple, readily available, and reproducible imaging marker to predict the prognosis
of patients with AIS after EVT.

Fluid enhancement reversal restores vascular elevation (FVH) defined as the circular, continuous, or punctate linear elevation of the subarachnoid space relative to the low density of cerebrospinal fluid, with typical arterial orientation
.
FVH
is found in approximately 45% to 100% of stroke patients with intracranial artery occlusion.
Regarding the relationship between FVH and prognosis in AIS patients undergoing EVT, most studies suggest that FVH may represent adequate collateral circulation compensation, which can delay the progression of ischemic lesions and improve prognosis
.

However, these results are based on pre-treatment FVH, and only a small number of studies have explored the relationship between
post-treatment FVH and stroke prognosis.
To our knowledge, to date, the relationship between FVH after treatment and prognosis for AIS patients undergoing EVT for LVO remains unclear
.

Recently, a study published in the journal European Radiology evaluated the relationship between post-treatment FVH and clinical or imaging variables, and explored the value of post-treatment FVH as an imaging marker for predicting the 3-month functional prognosis of AIS patients after EVT, providing a simple, accessible, and reproducible imaging predictive marker for clinical practice
.

This retrospective study evaluated data
from serial patients with anterior circulation macrovascular occlusion between July 2017 and February 2021.
Together with other variables, the status of
FVH after treatment in each patient was assessed.
A good outcome was defined as a 3-month improved Rankin scale score of 0-2
.
Chi-square's test, Fisher's precision test, independent sample t-test, multivariate logistic regression analysis, and receiver operation feature analysis
were used.

Of the 84 patients included, 48 (57.
1%) developed post-treatment FVH
.
Post-treatment FVH was significantly associated
with incomplete recanalization (P<0.
05) and low early CT change scores (P<0.
05) in the Alberta stroke program with post-treatment diffusion-weighted imaging.
The incidence of post-treatment haemorrhagic transformation was higher compared with those without post-treatment FVH (27.
1% vs.
16.
7%); However, this difference did not reach significance (p = 0.
259).

Probability of successful re-entry (odds [OR], 0.
024; 95% confidence interval [CI] 0.
003-0.
194; P<0.
05), with a lower NIHSSpre stroke scale score (NIHSSpre) on admission (OR, 1<b23>.
196; 95% CI, 1.
017 to 1.
406; P<0.
05), and FVH after no treatment (OR, 74.
690; 95% CI, 4.
624 to 1206.
421; P<0.
05) were</b10>

Figure A 74-year-old man presents with stroke syndrome (a)
due to occlusion of the right middle cerebral artery.
Postoperative angiography showed that the right middle cerebral artery was successfully revascularized after endovascular thrombectomy (B).

FVH (c, arrow)
is observed in the area of the right middle cerebral artery.
The treated DWI shows hyperintensity (d)
in the right temporal lobe and lateral ventricle.
The transition (e)
of bleeding is described on the SWI.
The mRS score was 3 at 3 months

This study shows that FVH after treatment is associated with poor clinical prognosis, providing important prognostic information
for patients with AIS after EVT.

Original source:

Xiao-Quan Xu,Guang-Chen Shen,Gao Ma,et al.
Prognostic value of post-treatment fluid-attenuated inversion recovery vascular hyperintensity in ischemic stroke after endovascular thrombectomy.
DOI:10.
1007/s00330-022-08886-1