To evaluate the prognostic value of hyperintense vessel (HV) in patients with acute middle cerebral artery (MCA) occlusion.

Seventy-four consecutive patients with first ever stroke(48 male and 26 female, the mean age was (60.7±15.3) years) in the territory of MCA, retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011, were enrolled as subjects. All subjects completed brain MRI, and MRA or DSA indicated proximal MCA occlusion. According to the location and extent of HV, all subjects were classified into 3 groups: without HV, proximal HV and distal HV. Clinical data were obtained and compared among patients with different grades of HV. Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke.

HV was observed in 49 (66.2%) of the 74 enrolled patients. Among patients with HV, 7(9.4%) were classified as proximal HV and 42 (56.8%) as distal HV. Initial NIHSS score (11（1—22）), 10-day NIHSS score (13.5(4—25)), infarction size (＞2/3：5 cases（6.8%）), and 90-day mRS score (3—6 scores: 12 cases（16.2%）) were significantly lower in patients with distal HV than those without (15（6—25）， Z=-3.544；7（0—22）， Z=-4.461；20 cases（27.0%）， χ²=20.916；27 cases（36.5%）， χ²=22.689；all P<0.01). The NIHSS score decreased from baseline to that on 10 days and the mRS score decreased from 10 days to that on 90 days in patients with distal HV was more than that in patients without distal HV. Multivariate analysis revealed that patients with older age (OR= 1.111， 95% CI 1.036—1.191，P=0.003), high infarction size (OR=3.679, 95% CI 1.35—10.025， P=0.011) worsened outcome, whereas distal HV (P=0.012, OR=0.131, 95% CI 0.027—0.638) improved outcome.

Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral artery occlusion.

Infarction;  middle cerebral artery; Cerebrovascular circulation; Collateral circulation; Magnetic resonance imaging; Prognosis