Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study

Abstract

Objective To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). Methods Patients with acute middle cerebral artery (MCA) occlusion who received EVT in three comprehensive hospitals were retrospectively evaluated. They were divided into four groups based on the presence or absence of HMCAS and corresponding CTA findings, among whom differences were compared. Univariate and multivariate logistic regression analyses were performed to investigate the association between HMCAS and HT and its subtypes. Results 318 patients were included, among whom 149 (46.9%) had HMCAS. Patients in the proximal positive HMCAS group had higher National Institute of Health Stroke Scale scores and lower Alberta Stroke Program Early CT Scores (ASPECTS) than those in the proximal negative HMCAS group. The rate of HT was higher in the proximal positive HMCAS group than that in the proximal negative HMCAS group. In multivariate logistic regression analysis, the proximal HMCAS were independently associated with HT (adjusted OR = 2.073, 95% CI 1.211–3.551, p = 0.008) and aHT (adjusted OR = 2.271, 95% CI 1.294–3.986, p = 0.004), but not with sHT. Patients who developed HT, including aHT and sHT, had a lower rate of good outcome. Conclusion Proximal HMCAS on initial NCCT was independently associated with aHT in patients who received EVT for acute MCA occlusion. Both aHT and sHT had a detrimental effect on clinical outcome.

The prognostic significance of hyperdense middle cerebral artery sign in cardioembolic stroke patients undergoing mechanical thrombectomy:a multicenter observational clinical study

“…The presence of proximal HMCAS was strongly associated with higher rates of HT, while proximal HMCAS patients exhibited signi cantly lower ASPECTS compared to their proximal HMCAS-negative counterparts. This disparity in ASPECTS may account for the increased frequency of hemorrhagic transformation in patients with positive proximal HMCAS [14]. Previous studies have consistently demonstrated that HMCAS is correlated with larger cerebral infarct volumes, measured using the "one-third middle cerebral artery area" principle or ASPECTS on initial NCCT scans [5,[15][16][17], which is a well-established risk factor for HT following MT [18][19][20].…”

“…Nevertheless, recent research has unveiled a link between asymptomatic hemorrhagic transformation (aHT) post-MT and worse functional results [21,22]. KANG et al [14] similarly identi ed that patients developing HT following MT reperfusion therapy, including aHT and sHT forms, exhibited lower rates of favorable outcomes. Correspondingly, in our study, HT was unequivocally linked to an unfavorable prognosis in CE patients.…”

Glial Fibrillary Acidic Protein as a Potential Indicator for Symptomatic Intracranial Hemorrhage in Acute Ischemic Patients Undergoing Endovascular Thrombectomy

“…3,5 Previous studies have consistently demonstrated that sICH is associated with an elevated risk of unfavorable clinical outcomes and a diminished benefit-to-risk ratio of EVT accordingly. [6][7][8] Hence, timely and precise identification of sICH following EVT holds importance for enhancing perioperative management and clinical prognosis.…”