Posttreatment FLAIR Hyperintense Vessels Refine mTICI-Based Reperfusion Phenotypes After Endovascular Thrombectomy.

Authors

Derek A Tsang, Mona Gad, Karthik Lalwani, Tobenna Ubachukwu, Hamza A Salim, Dhairya A Lakhani, Nathan Lu, Aakanksha Sriwastwa, Vivek S Yedavalli

Published in

AJNR. American journal of neuroradiology. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

The modified Thrombolysis in Cerebral Infarction (mTICI) scale is the standard angiographic measure of reperfusion after endovascular thrombectomy (EVT), but outcomes remain heterogeneous even after successful mTICI 2b-3 reperfusion. We evaluated whether posttreatment FLAIR hyperintense vessels (FHV) refine mTICI-based reperfusion phenotypes and identify patients with worse 90-day functional outcome after EVT for ICA, M1, or M2 occlusions.
This retrospective cohort study included patients with acute ischemic stroke due to ICA, M1, or M2 occlusion treated with EVT who had available final mTICI grade, posttreatment FLAIR assessment, and valid 90-day modified Rankin Scale (mRS). Successful angiographic reperfusion was defined as mTICI 2b-3. FHV status was dichotomized as FHV-, defined as NIH-FHV score 0, versus FHV+, defined as NIH-FHV score >0. Patients were categorized into four mTICI/FHV phenotypes. The primary outcome was favorable 90-day functional outcome, defined as mRS 0-2. Multivariable logistic regression was performed among patients with mTICI 2b-3 reperfusion, with FHV analyzed both dichotomously and per 1-point increase in NIH-FHV score.
A total of 205 patients were included: 132 had mTICI 2b-3/FHV-, 49 had mTICI 2b-3/FHV+, 8 had mTICI <2b/FHV-, and 16 had mTICI <2b/FHV+. Favorable 90-day outcome differed across phenotypes (p=.001). Among patients with mTICI 2b-3 reperfusion, favorable outcome occurred in 84/132 patients with FHV- (63.6%) versus 21/49 with FHV+ (42.9%). Persistent FHV was associated with lower adjusted odds of favorable outcome (adjusted OR, 0.26; 95% CI, 0.11-0.57; p<.001), and each 1-point increase in NIH-FHV score was similarly associated with lower odds (adjusted OR, 0.62; 95% CI, 0.45-0.83; p=.002).
Posttreatment FHV refined mTICI-based reperfusion phenotyping after ICA/M1/M2 EVT. Among patients with mTICI 2b-3 reperfusion, persistent FHV identified a clinically discordant phenotype associated with lower rates of favorable 90-day functional outcome.

PMID:
42580861
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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