Hyperdense Middle Cerebral Arteries Sign Detected by Multi-mode CT in Acute Ischemic Stroke: A Cohort Study

GUO Yi-jia, ZHU Jia-ying, HONG Ye. et al

Abstract

To determine the associations between hyperdense middle cerebral arteries sign (HMCAS) and large vessel occlusion (LVO) and clinical outcomes in patients with acute ischemic stoke. Methods Patients who were admitted to the Stroke Center of West China Hospital of Sichuan University within 6 h after onset of acute ischemic stroke from July 2015 to July 2017 were included in this study. Logistic regression models were established to determine the value of HMCAS in predicting LVO, hemorrhagic transformation and 90-d functional outcome using the receiver operating characteristic curve. Results A total of 292 stroke patients were recruited and 50 (17.1%) presented with HMCAS, including 41 (82.0%) with confirmed as LVO. HMCAS had a value of 0.682 in the area under the receiver operating characteristic curve for predicting LVO 〔odds ratio OR)=8.93, 95% confidence interval CI): 3.72-21.48, P<0.001), better than early CT infarct (0.682 vs. 0.602, P=0.038). HMCAS was also an independent predictor for hemorrhagic transformation OR=5.32, 95%CI: 2.16-13.11, P<0.001) and poor functional recovery OR=3.02, 95%CI: 1.19-7.62, P=0.019). Conclusion HMCAS is a risk factor of large artery occlusion, hemorrhagic transformation, and poor functional recovery in patients with acute ischemic stroke.

 

Keywords: Acute ischemic stroke, Hyperdense middle cerebral arteries sign, Large vessel occlusion, Prognosis 

 

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References


MAIRG. BOYD EV, CHAPPELL FM. et al. Sensitivity and specificity of the hyperdense artery sign for arterial obstruction in acute ischemic stroke. Stroke. 2015. 46 ( 1 ): 102-107.

KOU KH. CHANG FC. LAI YJ. et al. Hyperdense artery sign, clot characteristics, and response to intravenous thrombolysis in han Chinese people with acute large arterial infarction. J Stroke Cerebrovasc Dis,2016,25(3) ;695-701.

PIKIJAS, MAGDIC J, TRKULJA V, et al. Intracranial thrombus morphology and composition undergoes time- dependent changes in acute ischemic stroke; a CT densitometry study. Int J Mol Sci,2016,17( 11 ): 1959[2018- 01-18]. https://doi. org/10. 3390/ijmsl7111959.

ZOU M, CHURILOV L. HE A, et al. Hyperdense middle cerebral artery sign is associated with increased risk of hemorrhagic transformation after intravenous thrombolysis for patients with acute ischaemic stroke. J Clin Neurosci, 2013.20(7):984-987.

DEREX L. HERMIER M. ADELEINE Wetal. Clinical and imaging predictors of intracerebral haemorrhage in stroke patients treated with intravenous tissue plasminogen activator. J Neurol Neurosurg Psychiatry. 2005. 76 ( 1 ): 70- 75.

AMITRANO D. SILVA IR, LIBERATO BB, et al. Simple prediction model for unfavorable outcome in ischemic stroke after intravenous thrombolytic therapy. Arq Neuropsiquiatr. 2016,74(12) :986-989.

NIESTEN JM. VAN DER SCHAAF IC, VAN DER GRAAF Y, et al. Predictive value of thrombus attenuation on thin-slice non-contrast CT for persistent occlusion after intravenous thrombolysis. Cerebrovasc Dis,2014,37(2);116- 122.

MOFTAKHAR P. ENGLISH JD, COOKE DL, et al. Density of thrombus on admission ct predicts revascularization efficacy in large vessel occlusion acute ischemic stroke. Stroke,2013,44( 1);243-245.

KHARITONOVA T, AHMED N, THORENTM, et al. Hyperdense middle cerebral artery sign on admission CT scan-prognostic significance for ischaemic stroke patients treated with intravenous thrombolysis in the safe implementation of thrombolysis in stroke international stroke thrombolysis register. Cerebrovasc Dis,2009,27(1):51-59.

GARG N, ESHKAR N, TANENBAUM L. et al. Computed tomography angiographic correlates of early computed tomography signs in acute ischemic stroke. J Neuroimaging, 2004 *14(3): 242-245.

RAO NM, LEVINE SR. GOtfNBEIN JA, et al. Defining clinically relevant cerebral hemorrhage after thrombolytic therapy for stroke: analysis of the national institute of neurological disorders and stroke tissue-type plasminogen activator trials. Stroke.201 1.45(9) :2728-2733.

BRINJIKJI W, DUFFY S, BURROWS A, et al. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome; a systematic review. J Neurointerv Surg.2017.9(6):529-534.

SPORNSPB. HANNING U, SCHWINDT W. et al. Ischemic stroke; What does the histological composition tell us about the origin of the thrombus? Stroke, 2017. 48 ( 8): 2206-2210.

LINDLEY RI, WARDLAW JM, SANDERCOCK PA, et al. Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction. J Stroke Cerebrovasc Dis,2004,13(6);235-246.


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