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Distal Hyperintense Vessels on Flair: A Prognostic Indicator of Acute Ischemic Stroke

Huang X.a, b · Liu W.a · Zhu W.a · Ni G.b · Sun W.c · Ma M.a · Zhou Z.b · Wang Q.d · Xu G.a · Liu X.a
aDepartment of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, bDepartment of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, and cDepartment of Neurology, Jinling Hospital, Southern Medical University, Guangzhou, and dDepartment of Neurology, Affiliated Shenzhen Shajing Hospital of Guangzhou Medical University (Shajing People’s Hospital), Shenzhen , China Eur Neurol 2012;68:214–220 (DOI:10.1159/000340021)


Background: Hyperintense vessels (HVs) on fluid-attenuated inversion recovery (FLAIR) are frequently observed in acute ischemic stroke (AIS). The presence of HVs represents altered blood flow from collaterals distal to arterial occlusion or stenosis. This study aimed to evaluate the prognostic value of HVs in AIS. Methods: Fifty-four consecutive patients with acute middle cerebral artery occlusion were enrolled in the study. The location and extent of the HVs was determined by FLAIR. Clinical data were obtained and compared between patients with different grades of HVs. Additionally, the relationship between distal HVs and leptomeningeal collaterals (LMCs) was assessed using angiography. Results: HVs were observed in 41 (75.9%) of the 54 patients enrolled. The initial NIHSS score was lower (p < 0.001) and the infarction volume was smaller (p < 0.001) in patients with distal HVs. Adjusting of other factors, regression analysis revealed that distal HVs are an independent predictor of a favorable outcome at 90 days (p = 0.006; OR 0.049; 95% CI 0.006–0.420). Furthermore, the presence of distal HVs was correlated with the presence of LMCs. Conclusion: Distal HVs may be a marker for LMCs and act as a predictor of a favorable clinical outcome for patients with AIS.


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