Association of distal hyperintense vessel sign and recurrent stroke in patients with symptomatic intracranial stenosis

Hisham Salahuddin, Ali Saherwala, Marco C. Pinho, William Moore, Alicia Castonguay, Nadeem I. Khan, Faraz Jeelani, Hardeep Uppal, Henry He, Joel Campbell, Ty Shang

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The distal hyperintense vessel sign (DHV) on fluid-attenuated inversion recovery magnetic resonance image (MRI) is an imaging biomarker of slow leptomeningeal collateral flow in the presence of large artery stenosis or occlusion reflecting impaired cerebral hemodynamics. In this study, we aim to investigate the significance of the DHV sign in patients with symptomatic ≥ 70% intracranial atherosclerotic stenosis. Methods: We retrospectively reviewed patients with ischemic stroke or transient ischemic attack admitted to a single center from January 2010 to December 2017. Patients were included if they had symptomatic ≥ 70% atherosclerotic stenosis of the intracranial internal carotid artery or middle cerebral artery. The presence of the DHV sign was evaluated by blinded neuroradiologist and vascular neurologists. Recurrent ischemic stroke in the vascular territory of symptomatic intracranial artery was defined as new neurological deficits with associated neuroimaging findings during the follow up period. Results: A total of 109 patients were included in the study, of which 55 had DHV sign. Average duration of follow up was 297 ± 326 days. Four patients were lost during follow up. Patients with the DHV sign had a higher rate of recurrent ischemic stroke (38%), compared to patients without the DHV sign (17%; p=0.018). In multivariate regression analysis, the presence of DHV sign was an independent predictor of recurrent ischemic stroke. A DHV score of ≥ 2 had a 63% sensitivity and 69% specificity for recurrent ischemic stroke. Interpretation: In patients with severe symptomatic intracranial atherosclerotic stenosis, those with a DHV sign on MRI are at higher risk of recurrent ischemic stroke.

Original languageEnglish (US)
Article number106616
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number9
StatePublished - Sep 2022


  • Atherosclerosis
  • Distal hyperintense vessel
  • Hemodynamics
  • Intracranial stenosis
  • Ischemic stroke
  • MRI
  • Prevention of recurrent stroke

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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