Hyperdense middle cerebral artery sign is associated with increased risk of hemorrhagic transformation after intravenous thrombolysis for patients with acute ischaemic stroke

Zou, Ming; Чурилов, Леонид; He, Anna; Campbell, Bruce C.V.; Davis, Stephen M.; Yan, Bernard

doi:10.1016/j.jocn.2012.10.013

Cited by 35 publications

(37 citation statements)

References 16 publications

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“…The hyperdense artery sign was significantly more often present in the pure iPH group compared with the pure rPH group. This is not surprising, as the hyperdense artery sign is associated with hemorrhagic transformation of the ischemic area but not with rPH …”

Section: Discussionmentioning

confidence: 94%

Cerebral white matter lesions and post‐thrombolytic remote parenchymal hemorrhage

Curtze

Putaala

Sibolt

et al. 2016

Annals of Neurology

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Section: Discussionmentioning

confidence: 94%

Cerebral white matter lesions and post‐thrombolytic remote parenchymal hemorrhage

Curtze

Putaala

Sibolt

et al. 2016

Annals of Neurology

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“…We have also reaffirmed the concept that AHT is not clinically innocuous. The study unequivocally reiterates infarct size, stroke severity, large-artery occlusion, and cardioembolism defined by ASPECTS, NIHSS, HMCA sign, and AF respectively are well-established independent HT predictors [ 20 , 21 ]. In our HTI score, we use the presence of AF on ECG at admission rather than AF history for the reason discussed in the Results.…”

Section: Discussionmentioning

confidence: 99%

The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke

2017

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BackgroundWe aimed to develop a tool, the hemorrhagic transformation (HT) index (HTI), to predict any HT within 14 days after middle cerebral artery (MCA) stroke onset regardless of the intravenous recombinant tissue plasminogen activator (IV rtPA) use. That is especially important in the light of missing evidence-based data concerning the timing of anticoagulant resumption after stroke in patients with atrial fibrillation (AF).MethodsWe retrospectively analyzed 783 consecutive MCA stroke patients. Clinical and brain imaging data at admission were recorded. A follow-up period was 2 weeks after admission. The patients were divided into derivation (DC) and validation (VC) cohorts by generating Bernoulli variates with probability parameter 0.7. Univariate/multivariate logistic regression, and factor analysis were used to extract independent predictors. Validation was performed with internal consistency reliability and receiver operating characteristic (ROC) analysis. Bootstrapping was used to reduce bias.ResultsThe HTI was composed of 4 items: Alberta Stroke Program Early CT score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS), hyperdense MCA (HMCA) sign, and AF on electrocardiogram (ECG) at admission. According to the predicted probability (PP) range, scores were allocated to ASPECTS as follows: 10–7 = 0; 6–5 = 1; 4–3 = 2; 2–0 = 3; to NIHSS: 0–11 = 0; 12–17 = 1; 18–23 = 2; >23 = 3; to HMCA sign: yes = 1; to AF on ECG: yes = 1. The HTI score varied from 0 to 8. For each score, adjusted PP of any HT with 95% confidence intervals (CI) was as follows: 0 = 0.027 (0.011–0.042); 1 = 0.07 (0.043–0.098); 2 = 0.169 (0.125–0.213); 3 = 0.346 (0.275–0.417); 4 = 0.571 (0.474–0.668); 5 = 0.768 (0.676–0.861); 6 = 0.893 (0.829–0.957); 7 = 0.956 (0.92–0.992); 8 = 0.983 (0.965–1.0). The optimal cutpoint score to differentiate between HT-positive and negative groups was 2 (95% normal-based CI, 1–3) for the DC and VC alike. ROC area/sensitivity/specificity with 95% normal-based CI for the DC and VC were 0.85 (0.82–0.89)/0.82 (0.73–0.9)/0.89 (0.8–0.97) and 0.83 (0.78–0.88)/0.8 (0.66–0.94)/0.87 (0.73–1.0) respectively. McDonald’s categorical omega with 95% bias-corrected and accelerated CI for the DC and VC was 0.81 (0.77–0.84) and 0.82 (0.76–0.86) respectively.ConclusionsThe HTI is a simple yet reliable tool to predict any HT within 2 weeks after MCA stroke onset regardless of the IV rtPA use.

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“…The hyperdense artery sign has been reported in 17% to 50% of patients with middle cerebral artery (MCA) territory stroke and is associated with more severe neurological deficits, larger territory of infarction and worse functional outcome [3], [4]. Hyperdense artery sign can be categorized as proximal hyperdense middle cerebral artery sign (p-HMCAS) and distal hyperdense middle cerebral artery sign (d-HMCAS) on non-contrast CT according to the site of occlusion [4], [5].…”

Section: Introductionmentioning

confidence: 99%

Proximal Hyperdense Middle Cerebral Artery Sign Predicts Poor Response to Thrombolysis

Davis

Mitchell

et al. 2014

PLoS ONE

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The aim of our study was to compare the rapid neurological improvement after intravenous recombinant tissue-type plasminogen activator (rtPA) in patients with proximal hyperdense middle cerebral artery sign (p-HMCAS) to those without the sign and those with the distal hyperdense middle cerebral artery sign (d-HMCAS). Admission and 24 hour non-contrast CT scans of 120 patients with middle cerebral artery (MCA) territory stroke who were treated with intravenous rtPA were assessed for the presence of p-HMCAS and d-HMCAS. The sign was classified according to the site of occlusion. Rapid neurological improvement was defined as ≥50% improvement in the NIHSS score at 24 hours after thrombolysis. Rapid neurological recovery after thrombolysis was assessed and compared between the subgroups. Rapid neurological recovery was less common in the pooled group of patients with either p-HMCAS or d-HMCAS than those without the sign (p<0.01). Patients with p-HMCAS were less likely to have rapid neurological recovery than those with d-HMCAS (p<0.01). However, there was no difference in early neurological recovery between patients with d-HMCAS and those without any hyperdense sign. Our study showed that poor neurological recovery post rtPA was confined to p-HMCAS and not to d-HMCAS, indicating that these signs have quite different prognostic significance.

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Hyperdense middle cerebral artery sign is associated with increased risk of hemorrhagic transformation after intravenous thrombolysis for patients with acute ischaemic stroke

Cited by 35 publications

References 16 publications

Cerebral white matter lesions and post‐thrombolytic remote parenchymal hemorrhage

Cerebral white matter lesions and post‐thrombolytic remote parenchymal hemorrhage

The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke

Proximal Hyperdense Middle Cerebral Artery Sign Predicts Poor Response to Thrombolysis

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