Correlation Analysis Between FLAIR Vascular Hyperintensity And Efficacy Of Intravenous Thrombolysis With Rt-PA In Patients With Acute Middle Cerebral Artery Infarction

Objective:Intravenous thrombolysis has been proved to be an effective treatment for early ischemic stroke.Fluid-attenuated inversion recovery vascular hyperintensities(FVH)are frequently observed on FLAIR sequence in patients with acute cerebral infarction of middle cerebral artery stenosis or occlusion.The purpose of this study is to explore whether FVH can serve as a predictor for poor short-term efficacy in patients with acute stroke after intravenous thrombolysis.Methods:A retrospective analysis was performed on 51 patients with acute cerebral infarction of middle cerebral artery stenosis or occlusion who were admitted to the department of neurology of our hospital from January 2018 to September 2019,and received intravenous thrombolytic therapy within 6 hours from onset and completed the first routine craniocerebral MRI sequence examination within 24 hours after admission.FVH score was performed using an FVH-Alberta Stroke Program Early CT Score(ASPECTS)rating system.Early neurological impairment and improvement was evaluated by National Institute of Health stroke scale(NIHSS)and by oxfordshire community stroke project(OCSP)classification.Vessel stenosis or occlusion was detected by MRA.Poor short-term efficacy in patients were defined as a reduction of NTHSS score by less than 6 after thrombolytic therapy(ΔNIHSS<6).SPSS 22.0 was used for statistical analysis,Chi-square test,double sample Mest,Wilcoxon rank-sum test and multivariate logistic regression analysis were used for analysis and comparison.Results:Overall,51 patients were analyzed(mean age;64.1±11.4;maximum age,85;minimum age,40).The mean time interval from onset to thrombolysis(minutes)was longer in FVH positive group(208.7±68.9)or in ΔNIHSS<6 group(205.7±67.6)than that in FVH negative group(159.9 ± 62.7)or in ΔNIHSS ≥ 6 group(152.8 ± 67.7),respectively.NIHSS score of patients 24 hours after intravenous thrombclysis was higher in FVH positive group(9.4±5.9)than that in FVH negative group(5.4±3.9).The presence of FVH was significantly associated with vessel stenosis or occlusion(φ=0.536)and the subclassification of OCSP(φ=0.340).In multiple regression analyses,the presence of FVH was independently associated with poor short-term efficacy(ΔNIHSS score less than 6)(odds ratio,0.196;95%confidence interval,0.043-0.899).All the results mentioned above were statistically significant(P<0.05).Conclusion:FVH is an early independent predictor for poor short-term efficacy in patients with acute cerebral infarction after intravenous thrombolytic therapy.Therefore,FVH can help clinicians to select patients who will benefit more from thrombolytic therapy,and has considerable impact on clinical decision-making of individual and precise treatment for patients.