ArticleCerebrovascular diseases extra2026
Association of Posttreatment Hyperperfusion on Arterial Spin Labeling with Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Patients with Acute Ischemic Stroke after Endovascular Therapy.
Article in Cerebrovascular diseases extra, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe prognosis of patients with acute ischemic stroke (AIS) following endovascular therapy (EVT) is largely influenced by the extent of reperfusion. Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is a simple imaging sign which assessed based on fluid-attenuated inversion recovery (FLAIR) images. We aimed to evaluate whether FVH on posttreatment FLAIR can serve as a surrogate imaging marker of cortical hyperperfusion identified by arterial spin labeling (ASL) in patients with AIS after EVT.
methodsWe retrospectively enrolled 150 patients with AIS who achieved successful recanalization after EVT. Clinical data and posttreatment magnetic resonance imaging sequences including diffusion-weighted imaging (DWI), FLAIR, and ASL were systematically collected. The 150 patients were categorized into four groups based on DWI and FVH status (A: DWI-, FVH-; B: DWI+, FVH-; C: DWI-, FVH+; D: DWI+, FVH+). Perfusion was evaluated within six predefined Alberta Stroke Program Early CT Score (ASPECTS) regions (M1-M6) per patient, yielding a total of 900 cortical regions analyzed. The perfusion status was evaluated based on visual assessment of absolute cerebral blood flow maps derived from ASL, followed by statistical analysis.
resultsAmong the 900 cortical territories, 250 (27.78%) were classified as group A, 361 (40.11%) as group B, 55 (6.11%) as group C, and 234 (26.00%) as group D. Inter-rater agreement for evaluating the status of posttreatment FVH was excellent (κ = 0.851). There were significant differences in perfusion characteristics across four groups (p < 0.001). In subgroup analysis, group C exhibited a higher proportion of hyperperfusion compared to group A (21.82% vs. 15.20%), although the difference did not reach significance (p = 0.442), while group D demonstrated a significantly higher percentage of hyperperfusion relative to group B (48.72% vs. 34.34%, p < 0.001).
conclusionPositive FVH may be associated with post-EVT cortical hyperperfusion in AIS patients following successful revascularization.
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