Association of Hyperdense Middle Cerebral Artery Sign With Clinical Outcome in Patients Treated With Tissue Plasminogen Activator

Abstract

Background and Purpose-The hyperdense middle cerebral artery sign (HMCAS) is a marker of thrombus in the middle cerebral artery. The aim of our study was to find out the frequency of the HMCAS, its association with initial neurological severity and early parenchymal ischemic changes on CT, its relevance to clinical outcome, and the efficacy of intravenous recombinant tissue plasminogen activator (rtPA) in patients with the HMCAS. Methods-Secondary analysis of the data from 620 patients who received either rtPA or placebo in the European Cooperative Acute Stroke Study I (ECASS I), a double-blind, randomized, multicenter trial. The baseline CT scans were obtained within 6 hours from the onset of symptoms. Functional and neurological outcomes were assessed using the modified Rankin Scale and the Scandinavian Stroke Scale at day 90. Results-We found an HMCAS in 107 patients( 17.7%). The initial neurological deficit was more severe in patients with the HMCAS than in those lacking this sign (PϽ0.0001). Early cerebral edema and mass effect were also more common in patients with the HMCAS (PϽ0.0001). The HMCAS was related to the risk of poor functional outcome (grade of 3 to 6 on the modified Rankin Scale) on univariate analysis: 90 patients (84%) with the HMCAS and 310 patients (62%) lacking this sign were dependent or dead at day 90 (PϽ0.0001). However, this association was no longer significant in a logistic model accounting for the effect of age, sex, treatment with rtPA, initial severity of neurological deficit and early parenchymal ischemic changes on CT. Patients with the HMCAS who were given rtPA had better neurological recovery than those who received placebo (Pϭ0.0297). Conclusions-The HMCAS is associated with severe brain ischemia and poor functional outcome. However, it has no significant independent prognostic value when accounting for the effect of initial severity of neurological deficit and of early parenchymal ischemic changes on CT. Patients with the HMCAS may benefit from intravenous rtPA. (Stroke. 1999;30:769-772.)

CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct

“…2 Tandem internal carotid artery (ICA)/MCA occlusions have lower early recanalization and early neurologic improvement rates compared with isolated MCA occlusion. 9 Although the effects of clot burden have been indirectly examined via the hyperattenuated arterial sign on noncontrast CT (NCCT) 3,10,11 and directly via conventional angiographic studies, these have only recently been assessed and quantified with CT Angiography (CTA). 2 Many clinical and radiologic variables impact the decision for thrombolysis and route of administration.…”

Thrombus Volume Comparison between Patients with and without Hyperattenuated Artery Sign on CT

“…Patients with HAS in the M1 segment had more severe ischemia and poorer outcome than those without. 5,7 In addition, rapid estimation of the thrombus volume and its location may be helpful in determining treatment techniques, particularly in candidates for thrombolytic treatment. 8 The volume of the thrombus, as well as its location, can be one of the factors determining the presence of HAS.…”

Non-enhanced CT Maximum Intensity Projections for the Detection of Large Vessel Occlusions

“…dense MCA has been associated with severe neurological deficits, extensive brain damage, and poor clinical outcomes [15,16]. Similarly the presence of a hyper dense basilar artery on NECT is a strong predictor for basilar artery occlusion and poor functional outcomes [17].…”