Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack within the Anterior Circulation

Purpose. The aim of the present study was to evaluate the relationship of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) with haemodynamic abnormality and severity of arterial stenosis in patients with transient ischemic attack (TIA) of the carotid artery system. Patients and Methods. Consecutive inpatients (N = 38) diagnosed with TIAs of the carotid system in a 4-year period (2014–2017) were retrospectively analysed in our study and divided into FVH-negative and FVH-positive groups based on the presence of FVH sign. Each inpatient had undergone magnetic resonance imaging (MRI) followed by computed tomography (CT) perfusion imaging studies. We investigated the degree of arterial stenosis, number of stenosis, watershed regions, and related CT perfusion indexes, including hypoperfusion regions, mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). Spearman rank correlation was performed between FVHs score, the degree of arterial stenosis, and CT perfusion indexes with significant difference. Results. Thirty-one patients (81.6%) observed with FVH sign were assigned to the FVH-positive group. The hypoperfusion regions, MTT, and CBF values were significantly different between the FVH-negative group and FVH-positive groups. Spearman correlation analysis showed significant positive correlations between hypoperfusion regions, MTT, and FVHs scores (r = 0.755 and 0.674, respectively, p<0.01); a moderate negative correlation was found between CBF and FVHs scores (r = −0.525, p<0.01), whereas the degree of artery stenosis revealed no significant correlation with FVH scores (r = 0.253, p>0.05). Conclusion. Hyperintense vessels on FLAIR were closely associated with hypoperfused regions, MTT, and CBF values, which indicated that the presence of FVHs could be an important and convenient imaging marker of haemodynamic impairment in patients with TIA.

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Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Patients with Transient Ischemic Attack

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2017.05.034 ◽

2017 ◽

Vol 26 (10) ◽

pp. 2412-2415 ◽

Cited By ~ 3

Author(s):

Marcelo Marinho de Figueiredo ◽

Edson Amaro Júnior ◽

Maramélia Araújo de Miranda Alves ◽

Marcela Vazzoler ◽

Renata Carolina Acre Nunes Miranda ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Inversion Recovery ◽

Fluid Attenuated Inversion Recovery ◽

Ischemic Attack

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Clinical Significance of Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack

Stroke ◽

10.1161/strokeaha.111.000787 ◽

2013 ◽

Vol 44 (6) ◽

pp. 1635-1640 ◽

Cited By ~ 14

Author(s):

Junpei Kobayashi ◽

Toshiyuki Uehara ◽

Kazunori Toyoda ◽

Kaoru Endo ◽

Tomoyuki Ohara ◽

...

Keyword(s):

Clinical Significance ◽

Transient Ischemic Attack ◽

Inversion Recovery ◽

Fluid Attenuated Inversion Recovery ◽

Ischemic Attack

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Juxtacortical Spots on Fluid-Attenuated Inversion Recovery Images in Cryptogenic Transient Ischemic Attack

Journal of Clinical Neurology ◽

10.3988/jcn.2013.9.2.103 ◽

2013 ◽

Vol 9 (2) ◽

pp. 103 ◽

Cited By ~ 4

Author(s):

Dong-Eun Kim ◽

Min-Ji Choi ◽

Joon-Tae Kim ◽

Jane Chang ◽

Seong-Min Choi ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Inversion Recovery ◽

Fluid Attenuated Inversion Recovery ◽

Ischemic Attack

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Diminished Signal Intensities Distal to Intracranial Arterial Stenosis on Time-of-Flight MR Angiography Might Indicate Delayed Cerebral Perfusion

Cerebrovascular Diseases ◽

10.1159/000445842 ◽

2016 ◽

Vol 42 (3-4) ◽

pp. 232-239 ◽

Cited By ~ 10

Author(s):

Linfang Lan ◽

Xinyi Leng ◽

Jill Abrigo ◽

Hui Fang ◽

Vincent H.L. Ip ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Perfusion ◽

Cerebral Blood Volume ◽

Ct Perfusion ◽

Mean Transit Time ◽

Time Of Flight ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis ◽

Tof Mra ◽

Signal Intensities

Background: Intracranial arterial stenosis (ICAS) is a predominant cause of ischemic stroke in Asia. Changes in the signal intensities (SIs) across ICAS lesions on time-of-flight magnetic resonance angiography (TOF-MRA) have been indicated to partially reflect the hemodynamic significance of the lesions, which we aimed to verify by correlating it with cerebral perfusion features provided by CT perfusion (CTP) imaging. Methods: Ischemic stroke or transient ischemic attack patients with unilateral symptomatic stenosis (≥50%) of intracranial internal carotid artery or middle cerebral artery (MCA) were included in this study. Change of SIs across an ICAS lesion on TOF-MRA was calculated by the distal and proximal SI ratio (SIR). Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) within the MCA territory of ipsilateral and contralateral hemispheres were evaluated on the CTP images at the basal ganglia level. Relative CBV, CBF and MTT were defined as ratios of the values obtained from ipsilateral and contralateral hemispheres. The relationships between SIR and CTP parameters were analyzed. Results: Fifty subjects (74% male, mean age 62) were recruited. Overall, the mean SIR was 0.77 ± 0.17. SIR of ICAS was significantly, linearly and negatively correlated with ipsilateral CBV (r = -0.335, p = 0.017), ipsilateral MTT (r = -0.301, p = 0.034), and ipsilateral/contralateral MTT ratio (r = -0.443, p = 0.001). Conclusions: Diminished SIs distal to ICAS on TOF-MRA might be associated with delayed ipsilateral cerebral perfusion. Changes of the SIs across ICAS lesions on TOF-MRA may be a simple marker to reflect cerebral perfusion changes in patients with symptomatic ICAS.

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Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.790626 ◽

2021 ◽

Vol 13 ◽

Author(s):

Lichuan Zeng ◽

Jinxin Chen ◽

Huaqiang Liao ◽

Qu Wang ◽

Mingguo Xie ◽

...

Keyword(s):

Cerebrovascular Disease ◽

Cerebrovascular Diseases ◽

Inversion Recovery ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis ◽

Severe Stenosis ◽

Vessel Occlusion ◽

Retrograde Filling ◽

Fluid Attenuated Inversion Recovery ◽

Ischemic Attack

Neuroradiological methods play important roles in neurology, especially in cerebrovascular diseases. Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is frequently encountered in patients with acute ischemic stroke and significant intracranial arterial stenosis or occlusion. The mechanisms underlying this phenomenon and the clinical implications of FVH have been a matter of debate. FVH is associated with large-vessel occlusion or severe stenosis, as well as impaired hemodynamics. Possible explanations suggested for its appearance include stationary blood and slow antegrade or retrograde filling of the leptomeningeal collateral circulation. However, the prognostic value of the presence of FVH has been controversial. FVH can also be observed in patients with transient ischemic attack (TIA), which may have different pathomechanisms. Its presence can help clinicians to identify patients who have a higher risk of stroke after TIA. In this review article, we aim to describe the mechanism and influencing factors of FVH, as well as its clinical significance in patients with cerebrovascular disease.

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Abstract P426: Platelet Glycoprotein IIb/IIIa Inhibitors as an Adjunct to Stent Placement of Carotid Stenosis in Symptomatic Patients

Stroke ◽

10.1161/str.52.suppl_1.p426 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sachin M Bhagavan ◽

Ammad Ishfaq ◽

Muhammad F Ishfaq ◽

Mukaish Kumar ◽

Shruthi Pulimamidi ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Carotid Stenosis ◽

Transient Ischemic Attack ◽

Stent Placement ◽

Severe Disability ◽

Platelet Glycoprotein ◽

Carotid Stent ◽

Significant Difference ◽

Ischemic Attack

Background: Intra-arterial or intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors have been used as adjunct to stent placement of carotid stenosis in patients with ischemic stroke or transient ischemic attack. Objective: To determine the proportion of patients with ischemic stroke or transient ischemic attack who received platelet GP IIb/IIIa inhibitors as adjunct to carotid stent placement and associated outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1, 2000 to July 1, 2018. We identified patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis and received Abciximab, Eptifibatide, or Tirofiban. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 8.4 % of 4567 patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis received platelet GP IIb/IIIa inhibitors. Patients who received platelet GP IIb/IIIa inhibitors were more likely to experience cerebral ischemia (14.8% versus 7.5%) and undergo intubation/mechanical ventilation (4.4% versus 2%). There was a significant difference between patients who did or did not receive platelet GP IIb/IIIa inhibitors in terms of in hospital mortality rates (2.7% versus 1.2%, p=0.0152), none to mild disability (67.3% vs 75.7%, p=0.0003), and moderate to severe disability (30.1% vs 23.1%,p=0.0024). Conclusions: Adjunct use of platelet GP IIb/IIIa inhibitors in patients undergoing carotid stent placement for symptomatic carotid stenosis was associated with increased rates of in hospital mortality and moderate to severe disability.

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Sleep-Related Leg Movements in Patients with Transient Ischemic Attack and Controls

European Neurology ◽

10.1159/000487666 ◽

2018 ◽

Vol 79 (3-4) ◽

pp. 171-176 ◽

Cited By ~ 2

Author(s):

Mirjam H. Schipper ◽

Korné Jellema ◽

Diego Alvarez-Estevez ◽

Johan Verbraecken ◽

Roselyne M. Rijsman

Keyword(s):

Cardiovascular Diseases ◽

Transient Ischemic Attack ◽

Sleep Apnea Syndrome ◽

Control Group ◽

Periodic Leg Movements ◽

Obstructive Sleep ◽

Increased Risk ◽

Significant Difference ◽

Ischemic Attack ◽

Leg Movements

Background: Periodic leg movements during sleep (PLMS) have been associated with an increased risk for cardiovascular diseases and there is a high prevalence of PLMS found in patients with obstructive sleep apnea syndrome (OSAS). We evaluated patients with transient ischemic attack (TIA) for PLMS and respiratory related leg movements (RRLM), versus a control group without TIA. Methods: Twenty-five patients with TIA and 34 patients with no vascular diagnosis were referred for polysomnography. Diagnosis of PLMS was made if the periodic leg movement index (PLMI) was ≥5 and clinical significant as PLMI ≥15. Results: There was no significant difference in PLMI ≥5 and ≥15 between patients with and without TIA. In the absence of OSAS, 2 out of 5 TIA patients (40%) had a PLMI ≥15 compared to 1 of the 19 patients without TIA (5%; p = 0.037). There was no increase in RRLMs when OSAS was present. Conclusions: TIA patients did not have higher PLMI compared to controls, and in the presence of OSAS, there was no increase in RRLMs compared to patients without TIA. In selective patients, PLMS could be associated with cardiovascular diseases, since PLMS was clinically more often found in the TIA group without OSAS.

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Abstract 2619: Autoregulation of Cerebral Blood Flow is Preserved in Primary Intracerebral Hemorrhage

Stroke ◽

10.1161/str.43.suppl_1.a2619 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

E B Gould ◽

Rebecca McCourt ◽

Sana Vahidy ◽

Negar Asdaghi ◽

Michael D Hill ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Intracerebral Hemorrhage ◽

Cerebral Autoregulation ◽

Cerebral Blood Volume ◽

Ct Perfusion ◽

Mean Transit Time ◽

Serial Ct ◽

Acute Intracerebral Hemorrhage ◽

Perfusion Maps

Background: Treatment of hypertension during acute intracerebral hemorrhage (ICH) is controversial. There are concerns that in the context of disrupted cerebral autoregulation, blood pressure (BP) reduction may cause decreased cerebral blood flow (CBF), particularly in the perihematoma region. CBF was assessed using serial CT perfusion (CTP) studies. We hypothesized that CBF would remain stable following BP reduction. Methods: Acute primary ICH patients were imaged pre and post BP treatment. Perfusion maps were calculated from CTP source images. Mean CBF was measured in a 1cm perihematoma region, contralateral homologous regions and in both hemispheres. Mean cerebral blood volume (CBV), mean transit time (MTT), and time to drain (TTD) were calculated in the same manner. Relative measures (i.e. rCBF) were calculated as ratios/differences between ipsilateral and contralateral regions. Results: Sixteen patients (median age 75 (54-91)) were imaged with CTP (median time from onset 19.4 (2.0-72.2) h) and re-imaged 2.0 (1.1-3.3) h later. Median NIHSS at baseline was 9 (2-24); this remained stable at the time of the second CTP (10 (2-24), P=0.14). Baseline hematoma volume was 24.8±19.9 ml and there was no change at the time of the second CTP (26.3±22.1 ml, P=0.16). Patients were recruited from an ongoing trial, in which they were randomly treated to a target systolic BP of <150mmHg (n=9) or <180mmHg (n=7). Four patients received no antihypertensives as BP was below target at the time of randomization. Mean systolic BP in treated patients (n=12) decreased significantly between the first (165±23 mmHg) and second (143±18 mmHg, P<0.0001) CTP scans. Mean perihematoma CBF in treated patients was stable with BP reduction (pre=35.1±7.1 vs. post=35.4±6.2 ml/100g/min, P=0.87). Ipsilateral hemispheric CBF was also stable (pre=47.3±7.2 vs. post=46.4±7.1 ml/100g/min, P=0.66). Although perihematoma CBF was lower than in contralateral homologous regions (rCBF=0.72±0.11), BP reduction did not decrease this further (0.74±0.14 post-treatment, P=0.58). Ipsilateral hemispheric rCBF (0.96±0.06) was also unaffected by BP treatment (0.95±0.08, P=0.64). Perihematoma rCBF decreased in 5 treated patients, but never by >12%. Linear regression showed no relationship between changes in systolic BP and perihematoma rCBF (R=-0.002, [-0.005, 0.001], P=0.18). Perihematoma rCBV (pre=0.77±0.11 vs. post=0.79±0.10, P=0.20), rMTT (pre=0.51±0.54s vs. post=0.70±0.65s, P=0.26) and rTTD (pre=0.71±1.01s vs. post=0.89±0.84s, P=0.42) also remained stable following BP treatment. Conclusions: Acute BP reduction does not appear to exacerbate perihematoma oligaemia. Stability of CBF following acute BP treatment suggests preservation of cerebral autoregulation in ICH, within the range of arterial pressures studied. These findings support the safety of early BP treatment in ICH.

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Abstract WP49: Distal Hyperintense Vessels Were not a Predictor of Large Vessel Occlusion in Patients With Transient Ischemic Attack

Stroke ◽

10.1161/str.47.suppl_1.wp49 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Marcelo M de Figueiredo ◽

Marcela R Vazzoller ◽

Edson Amaro Jr ◽

Renata A Miranda ◽

Gisele S Silva

Keyword(s):

Transient Ischemic Attack ◽

Surrogate Marker ◽

Multivariate Logistic Regression Analysis ◽

Clinical Information ◽

Large Vessel ◽

Arterial Stenosis ◽

Large Artery ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Ischemic Attack

Introduction: Distal hyperintense vessels (DHV) detected by FLAIR imaging are not uncommon in patients with acute ischemic stroke. The presence of DHV and its predictors has been scarcely evaluated in patients with transient ischemic attack (TIA), being associated to the presence of large vessel occlusion in such patients. We assessed the hypothesis that DHV are frequent in patients with TIA and do correlate with relevant clinical and neuroimaging characteristics. Methods: We evaluated a database of consecutive patients admitted with TIA from February 2009 to June 2012 who had undergone magnetic resonance imaging within 30 h of symptoms onset and intracranial and extracranial vascular imaging. We analyzed the relationship between DHV, clinical presentation, risk factors, neuroimaging characteristics and large artery stenosis or occlusion. DHV signals were defined on FLAIR images as focal, linear or serpentine, hyperintense signals relative to gray matter. Two neuroradiologists blinded to clinical information reached consensus regarding the presence of DHV. Results: Seventy-two TIA patients were enrolled. The median time from symptoms onset to MRI was 8:39 h [4:21, 14:13]. DHV signals on FLAIR images were present in 12 (16.7 %) patients. The overall agreement between examiners was good (k 0.67). Patients with DHV had more atrial fibrillation (AF) than those without (41.7% versus 21.7%, p=0.05) and a trend towards more congestive heart failure (CHF) (8.3% versus 1.7%, p=0.2) and diabetes (41.7% versus 21.7%, p=0.1). There were no differences in the frequency of intracranial or cervical arterial stenosis, cerebral microbleeds and white matter abnormalities in patients with and without DHV. In a multivariate logistic regression analysis, only AF had a trend to be a predictor of DHV (OR=4.24, p=0.1). The statistical model to predict DHV including AF, diabetes, and CHF had a moderate fit in terms of discrimination (c statistic=0.62) Conclusion: DHV signals on FLAIR images occur in patients with TIA and might correlate with clinical variables like AF and not only with large vessel occlusion as previously described. The presence of DVH in patients with TIA and AF might be a surrogate marker for a previous large vessel occlusion spontaneously recanalized.

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Collateral Circulation Predicts the Size of the Infarct Core and the Proportion of Salvageable Penumbra in Hyperacute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Cerebrovascular Diseases ◽

10.1159/000439064 ◽

2015 ◽

Vol 40 (3-4) ◽

pp. 182-190 ◽

Cited By ~ 18

Author(s):

Harri Rusanen ◽

Jukka T. Saarinen ◽

Niko Sillanpää

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Collateral Circulation ◽

Cerebral Blood Volume ◽

Treatment Time ◽

Ct Perfusion ◽

Mean Transit Time ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

The Impact

Background: We studied the impact of collateral circulation on CT perfusion (CTP) parametric maps and the amount of salvaged brain tissue, the imaging and clinical outcome at 24 h and at 3 months in a retrospective acute (<3 h) stroke cohort (105 patients) with anterior circulation thrombus treated with intravenous thrombolysis. Methods: Baseline clinical and imaging information were collected and groups with different collateral scores (CS) were compared. Binary logistic regression analyses using good CS (CS ≥2) as the dependent variable were calculated. Results: CTP Alberta Stroke Program Early CT Score (ASPECTS) was successfully assessed in 58 cases. Thirty patients displayed good CS. Poor CS were associated with more severe strokes according to National Institutes of Health Stroke Scale (NIHSS) at arrival (15 vs. 7, p = 0.005) and at 24 h (10 vs. 3, p = 0.003) after intravenous thrombolysis. Good CS were associated with a longer mean onset-to-treatment time (141 vs. 121 min, p = 0.009) and time to CTP (102 vs. 87 min, p = 0.047), better cerebral blood volume (CBV) ASPECTS (9 vs. 6, p < 0.001), better mean transit time (MTT) ASPECTS (6 vs. 3, p < 0.001), better noncontrast CT (NCCT) ASPECTS (10 vs. 8, p < 0.001) at arrival and with favorable clinical outcome at 3 months (modified Rankin Scale ≤2, p = 0.002). The fraction of penumbra that was salvageable at arrival and salvaged at 24 h was higher with better CS (p < 0.001 and p = 0.035, respectively). In multivariate analysis, time from the onset of symptoms to imaging (p = 0.037, OR 1.04 per minute, 95% CI 1.00-1.08) and CBV ASPECTS (p = 0.001, OR 2.11 per ASPECTS point, 95% CI 1.33-3.34) predicted good CS. In similar multivariable models, MTT ASPECTS (p = 0.04, OR 1.46 per ASPECTS point, 95% CI 1.02-2.10) and NCCT ASPECTS predicted good CS (p = 0.003, OR 4.38 per CT ASPECTS point, 95% CI 1.66-11.55) along with longer time from the onset of symptoms to imaging (p = 0.045, OR 1.03 per minute, 95% CI 1.00-1.06 and p = 0.02, OR 1.05 per minute, 95% CI 1.00-1.09, respectively). CBV ASPECTS had a larger area under the receiver operating characteristic curve for good CS (0.837) than NCCT ASPECTS (0.802) or MTT ASPECTS (0.752) at arrival. Conclusions: Favorable CBV ASPECTS, NCCT ASPECTS and MTT ASPECTS are associated with good CS along with more salvageable tissue and longer time from the onset of symptoms to imaging in ischemic stroke patients treated with intravenous thrombolysis.

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