Abstract W MP22: Hyperdense MCA Sign as a Recanalization and Outcomes Predictor of IA Thrombectomy
Background: The hyperdense MCA sign (HMCAS) is related to poor clinical outcomes and low recanalization rates after IV TPA. We explored the association between presence of HMCAS and clinical /procedural outcomes in patients with M1 MCA occlusion treated at our institution with endovascular therapy within the last five years.
Methods: We retrospectively collected from our mechanical thrombectomy database a total of 193 patients with M1 occlusion, of which 107 patients were found to have HMCAS (55%). Eligible patients were treated with IV TPA prior to the intra-arterial thrombectomy. A blinded stroke neurologist evaluated baseline head CT done for possible HMCAS and measured the MCA Hounsfield Units (HU). Procedure times and other clinical and radiographic parameters were calculated.
Results: A positive correlation between presence of HMCAS and procedure duration (mean time with HMCAS 112.3 min versus 89.89 min in the non HMCAS group P<0.05) was found. Intraprocedural perforation was 8% (n=9) in the HMCAS group versus 1% (n=1) in the non HMCAS group (P<0.05).Hounsfield Unit analysis (ratio of ipsilateral side/contralateral side), showed a linear correlation (p<0.05) between this ratio and procedure duration (Graph 1).
Conclusions: HMCAS is associated with slower recanalization, higher rate of complications and lack of differences in clinical outcomes possibly explained by low power after endovascular therapy. This association may reflect differences in thrombus composition or thrombus burden which should be taken into account when choosing recanalization strategies.Further studies focused on clot analysis and better understanding of clot's structure, may serve a future role in selecting special treatment options for acute stroke patients.
Author Disclosures: A. Horev: None. D.G. Romero: None. B.T. Jankowitz: None. A. Aghaebrahim: None. C.L. Kenmuir: None. A. Jadhav: None. T.G. Jovin: None.
- © 2014 by American Heart Association, Inc.