(Stroke. 1999;30:769-772.)
© 1999 American Heart Association, Inc.
Original Contributions |
Association of Hyperdense Middle Cerebral Artery Sign With Clinical Outcome in Patients Treated With Tissue Plasminogen Activator
From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium.
Correspondence to Vincent Larrue, MD, Department of Neurology, Rangueil Hospital, 1 Avenue Jean Pouilhès, 31403 Toulouse, France. E-mail larrue.v{at}chu-toulouse.fr
Background and Purpose—The hyperdense middle cerebral artery sign (HMCAS) is a marker of thrombus in the middle cerebral artery. The aim of our study was to find out the frequency of the HMCAS, its association with initial neurological severity and early parenchymal ischemic changes on CT, its relevance to clinical outcome, and the efficacy of intravenous recombinant tissue plasminogen activator (rtPA) in patients with the HMCAS.
Methods—Secondary analysis of the data from 620 patients who received either rtPA or placebo in the European Cooperative Acute Stroke Study I (ECASS I), a double-blind, randomized, multicenter trial. The baseline CT scans were obtained within 6 hours from the onset of symptoms. Functional and neurological outcomes were assessed using the modified Rankin Scale and the Scandinavian Stroke Scale at day 90.
Results—We found an HMCAS in 107 patients(17.7%). The initial neurological deficit was more severe in patients with the HMCAS than in those lacking this sign (P<0.0001). Early cerebral edema and mass effect were also more common in patients with the HMCAS (P<0.0001). The HMCAS was related to the risk of poor functional outcome (grade of 3 to 6 on the modified Rankin Scale) on univariate analysis: 90 patients (84%) with the HMCAS and 310 patients (62%) lacking this sign were dependent or dead at day 90 (P<0.0001). However, this association was no longer significant in a logistic model accounting for the effect of age, sex, treatment with rtPA, initial severity of neurological deficit and early parenchymal ischemic changes on CT. Patients with the HMCAS who were given rtPA had better neurological recovery than those who received placebo (P=0.0297).
Conclusions—The HMCAS is associated with severe brain ischemia and poor functional outcome. However, it has no significant independent prognostic value when accounting for the effect of initial severity of neurological deficit and of early parenchymal ischemic changes on CT. Patients with the HMCAS may benefit from intravenous rtPA.
Key Words: stroke assessment • stroke outcome • stroke, acute • thrombolytic therapy • tomography, x-ray computed
This article has been cited by other articles:
 |
|
 |
|
  D Manawadu and K Butcher Evolving hyperdense middle cerebral artery sign J. Neurol. Neurosurg. Psychiatry, October 1, 2008; 79(10): 1106 - 1106. [Full Text] [PDF]
|
|
|
|
 |
|
 O. Ozdemir, A. Leung, M. Bussiere, V. Hachinski, and D. Pelz Hyperdense Internal Carotid Artery Sign: A CT Sign of Acute Ischemia Stroke, July 1, 2008; 39(7): 2011 - 2016. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E.Y. Kim, E. Yoo, H.Y. Choi, J.W. Lee, and J.H. Heo Thrombus Volume Comparison between Patients with and without Hyperattenuated Artery Sign on CT AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 359 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Mattle, M. Arnold, D. Georgiadis, C. Baumann, K. Nedeltchev, D. Benninger, L. Remonda, C. von Budingen, A. Diana, A. Pangalu, et al. Comparison of Intraarterial and Intravenous Thrombolysis for Ischemic Stroke With Hyperdense Middle Cerebral Artery Sign Stroke, February 1, 2008; 39(2): 379 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. K. Shetty The MCA Dot Sign Radiology, October 1, 2006; 241(1): 315 - 318. [Full Text] [PDF]
|
|
|
|
|
|
T. Krings, D. Noelchen, M. Mull, K. Willmes, I. G. Meister, P. Reinacher, R. Toepper, and A. K. Thron The Hyperdense Posterior Cerebral Artery Sign: A Computed Tomography Marker of Acute Ischemia in the Posterior Cerebral Artery Territory Stroke, February 1, 2006; 37(2): 399 - 403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Y. Kim, S.-K. Lee, D. J. Kim, S.-H. Suh, J. Kim, J. H. Heo, and D. I. Kim Detection of Thrombus in Acute Ischemic Stroke: Value of Thin-Section Noncontrast-Computed Tomography Stroke, December 1, 2005; 36(12): 2745 - 2747. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Wardlaw and O. Mielke Early Signs of Brain Infarction at CT: Observer Reliability and Outcome after Thrombolytic Treatment--Systematic Review Radiology, May 1, 2005; 235(2): 444 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P A Barber, A M Demchuk, M D Hill, J H W. Pexman, M E Hudon, R Frayne, and A M Buchan The probability of middle cerebral artery MRA flow signal abnormality with quantified CT ischaemic change: targets for future therapeutic studies J. Neurol. Neurosurg. Psychiatry, October 1, 2004; 75(10): 1426 - 1430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Brown, K. C. Johnston, D. P. Wagner, and E. C. Haley Jr Predicting Major Neurological Improvement With Intravenous Recombinant Tissue Plasminogen Activator Treatment of Stroke Stroke, January 1, 2004; 35(1): 147 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Leary, C. S. Kidwell, J. P. Villablanca, S. Starkman, R. Jahan, G. R. Duckwiler, Y. P. Gobin, S. Sykes, K. J. Gough, K. Ferguson, et al. Validation of Computed Tomographic Middle Cerebral Artery """Dot""" Sign: An Angiographic Correlation Study Stroke, November 1, 2003; 34(11): 2636 - 2640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. F. Tomandl, E. Klotz, R. Handschu, B. Stemper, F. Reinhardt, W. J. Huk, K.E. Eberhardt, and S. Fateh-Moghadam Comprehensive Imaging of Ischemic Stroke with Multisection CT RadioGraphics, May 1, 2003; 23(3): 565 - 592. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J M Wardlaw, T M West, P A G Sandercock, S C Lewis, and O Mielke Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation J. Neurol. Neurosurg. Psychiatry, April 1, 2003; 74(4): 452 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Somford, P. J. Nederkoorn, D. R. Rutgers, L. J. Kappelle, W. P. T. M. Mali, and J. van der Grond Proximal and Distal Hyperattenuating Middle Cerebral Artery Signs at CT: Different Prognostic Implications Radiology, June 1, 2002; 223(3): 667 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Barber, A. M. Demchuk, M. E. Hudon, J.H. W. Pexman, M. D. Hill, and A. M. Buchan Hyperdense Sylvian Fissure MCA "Dot" Sign : A CT Marker of Acute Ischemia Stroke, January 1, 2001; 32(1): 84 - 88. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Baracchini, R. Manara, M. Ermani, and G. Meneghetti The Quest for Early Predictors of Stroke Evolution : Can TCD Be a Guiding Light? Stroke, December 1, 2000; 31(12): 2942 - 2947. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Barber, D. G. Darby, P. M. Desmond, R. P. Gerraty, Q. Yang, T. Li, D. Jolley, G. A. Donnan, B. M. Tress, and S. M. Davis Identification of Major Ischemic Change : Diffusion-Weighted Imaging Versus Computed Tomography Stroke, October 1, 1999; 30(10): 2059 - 2065. [Abstract] [Full Text] [PDF]
|
|