Prognostic capacity of hyperdense middle cerebral artery sign in anterior circulation acute ischaemic stroke patients receiving reperfusion therapy: a systematic review and meta-analysis

Abstract

Pre-intervention CT imaging-based biomarkers, such as hyperdense middle cerebral artery sign (HMCAS) may have a role in acute ischaemic stroke prognostication. However, the clinical utility of HMCAS in settings of reperfusion therapy and the level of prognostic association is still unclear. This systematic review and meta-analysis investigated the association of HMCAS sign with clinical outcomes and its prognostic capacity in acute ischaemic stroke patients treated with reperfusion therapy. Prospective and retrospective studies from the following databases were retrieved from EMBASE, MEDLINE and Cochrane. Association of HMCAS with functional outcome, symptomatic intracerebral haemorrhage (sICH) and mortality were investigated. The random effect model was used to calculate the risk ratio (RR). Subgroup analyses were performed for subgroups of patients receiving thrombolysis (tPA), mechanical thrombectomy (EVT) and/or combined therapy (tPA + EVT). HMCAS significantly increased the rate of poor functional outcome by 1.43-fold in patients (RR 1.43; 95% CI 1.30–1.57; p < 0.0001) without any significant differences in sICH rates (RR 0.91; 95% CI 0.68–1.23; p = 0.546) and mortality (RR 1.34; 95% CI 0.72–2.51; p = 354) in patients with positive HMCAS as compared to negative HMCAS. In subgroup analyses, significant association between HMCAS and 90 days functional outcome was observed in patients receiving tPA (RR 1.53; 95% CI 1.40–1.67; p < 0.0001) or both therapies (RR 1.40; 95% CI 1.08–1.80; p = 0.010). This meta-analysis demonstrated that pre-treatment HMCAS increases risk of poor functional outcomes. However, its prognostic sensitivity and specificity in predicting long-term functional outcome, mortality and sICH after reperfusion therapy is poor. Supplementary Information The online version contains supplementary material available at 10.1007/s13760-021-01720-3.

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

“…The recruitment of immune cells following an ischemic event may be a contributing factor to this association [ 33 ]. This study used arterial spin labelling (ASL) to characterise PLH, demonstrating how advanced imaging, such as computed tomography perfusion (CTP) [ 34 , 35 ], CT angiography (CTA) [ 36 ] and ASL [ 19 ], have allowed quantitative estimation and characterisation of cerebral perfusion and the delineation of angiographic features including collateral status in AIS patients [ 14 , 16 ].…”

“…The modified Jadad analysis, a scoring system that analyses the methodology of a trial, was used to assess the quality of each included study [ 13 , 14 ]. The risk of funding bias was also assessed by analysing the sources of funding for each study [ 15 , 16 ].…”

Incidence of white matter lesions in hospitalized COVID‐19 patients: A meta‐analysis

“…Studies included in the meta‐analysis all obtained a score of 3. Each study was also separately assessed for risk of funding bias using a 4‐point scale that scored studies from 0 (low potential for bias) to 3 (high potential for bias) 11 …”

“…Each study was also separately assessed for risk of funding bias using a 4‐point scale that scored studies from 0 (low potential for bias) to 3 (high potential for bias). 11 The absence of industry funding was not taken to signify an absence of bias, but the presence of industry funding or conflicts of interest was assumed to be an indicator of bias. None of the included studies were found to have high potential for bias.…”

Acute Ischaemic Stroke in Infective Endocarditis: Pathophysiology and Clinical Outcomes in Patients Treated with Reperfusion Therapy

“…Reperfusion therapy, via IVT and/or EVT, is the mainstay treatment available for AIS [7,39]. Whilst the factors mediating outcomes of reperfusion therapy in AIS have been well documented [40][41][42][43][44][45][46][47], our understanding of such clinical, imaging and systems variables in the setting of IE remains sub-optimal. Current guidelines for AIS recommend the use of IVT before EVT if presentation occurs within 4.5 h of symptom onset [48].…”