Proximal Hyperdense Middle Cerebral Artery Sign Predicts Poor Response to Thrombolysis

Abstract

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.

Intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign: A meta‐analysis

“…32,33 It was possible that further classification might help to explore additional associations with clinical outcomes. First, the radio- This study suggested that p-HMCAS, rather than d-HMCAS, was associated with more severe neurological deficit and decreased early recovery, which was speculated to be due to a greater clot burden.…”

“…In a previous study of 148 subjects, HMCAS was This study suggested that p-HMCAS, rather than d-HMCAS, was associated with more severe neurological deficit and decreased early recovery, which was speculated to be due to a greater clot burden. 32,33 It was possible that further classification might help to explore additional associations with clinical outcomes.…”

Disappearance of the Hyperdense Mca Sign after Stroke Thrombolysis: Implications for Prognosis and Early Patient Selection for Clot Retrieval

“…17 Patients with more proximal HMCAS are less likely to improve clinically, and HMCAS disappearance is less likely than those with a distally located HMCAS. 1,18 Furthermore, our population age is older than those included in previous studies. 1,8 Some studies suggest patients with cardioembolic stroke or atrial fibrillation are more likely to recanalise with intravenous thrombolysis.…”

Acute Ischemic Stroke: A Review of Imaging, Patient Selection, and Management in the Endovascular Era. Part I: Initial Management and Imaging

“…28 They indicate a reduced efficacy of IVT. 29 Magnetic resonance imaging: The stroke MRI protocol should aim to be minimalistic and efficient and should be practiced only in hospitals that have the infrastructure to maintain the door-to-needle or door-to-puncture times within the prescribed limits. Every delay of 30 minutes increases the risk of poor functional outcome by 14%.…”