Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy

Mechanical thrombectomy (MT) has dramatically improved the treatment of acute ischemic stroke (AIS) due to large-vessel occlusion. However, recent studies indicated that 25% to 54% of patients experience a poor functional outcome at 3-months despite a successful angiographic recanalization [1], [2], [3]. Some authors have termed this condition futile recanalization, which is defined by a 3-month modified Rankin Scale (mRs) > 2 in patients with a modified Thrombolysis In Cerebral Infarction (mTICI) score 2B-3. Several factors modifying the efficacy of MT have been identified [1,[3], [4], [5], [6], [7], [8], [9]]. In this regard, older age, hypertension, large baseline ischemic core, microangiopathy, microbleeds, brain atrophy and longer time from symptoms onset to recanalization are associated with less benefit [1,[3], [4], [5], [6], [7], [8], [9]]. Conversely, MT is more beneficial as stroke severity, as assessed by baseline National Institute of Health Stroke Scale (NIHSS) score, increases [10,11].

The degree of collateral circulation is a critical prognostic factor in AIS because it promotes a higher rate of effective recanalization and contributes to the salvage of ischemic penumbra, thereby limiting infarct growth, and basically improving clinical outcome[12,13].

Vascular hyperintensities on fluid-attenuated inversion recovery (FLAIR) images (VHF) are thought to be a surrogate marker of cerebral collateral status [14,15]. Extensive VHF on magnetic resonance imaging (MRI) examination at admission are associated with a good functional outcome and have been proposed as an alternative for patient selection [16]. However, the prognostic value of VHF is less known in patients achieving effective recanalization after MT.

The purpose of this study was to examine the prognostic value of VHF observed on admission MRI in patients with AIS and successful recanalization after MT.

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