Absent hyperdense middle cerebral artery sign is associated with poor functional outcome after mechanical thrombectomy

Abstract

Background The hyperdense middle cerebral artery sign on computed tomography indicates proximal middle cerebral artery occlusion. Recent reports suggest an association between the hyperdense sign and successful reperfusion. The prognostic value of the hyperdense middle cerebral artery sign in patients receiving mechanical thrombectomy has not been extensively studied. Aims Our study aims to evaluate the association between the hyperdense middle cerebral artery sign and functional outcome in patients with M1 occlusions that had undergone mechanical thrombectomy. Methods We conducted a single-center retrospective observational cohort study of 102 consecutive patients presenting with acute M1 occlusions that had undergone mechanical thrombectomy. Patients were stratified into cohorts based on the presence of hyperdense middle cerebral artery sign visually assessed on computed tomography by two readers. The outcomes of interests were functional disability measured by the ordinal Modified Rankin Scale (mRS) at 90 days, mortality, reperfusion status and hemorrhagic conversion. Results Out of the 102 patients with M1 occlusions, 71 had hyperdense middle cerebral artery sign. There was no significant difference between the cohorts in age, baseline mRS, NIHSS, ASPECTS, and time to reperfusion. The absence of hyperdense middle cerebral artery sign was associated with increased odds of being dependent or dying (higher mRS) (OR: 3.24, 95% CI: 1.30–8.06, p = 0.011) after adjusting for other significant predictors, including age, female sex, hypertension, presenting serum glucose, ASPECTS, CTA collateral score, and successful reperfusion. Conclusion The absence of hyperdense middle cerebral artery sign is associated with worse functional outcome in patients presenting with M1 occlusions undergoing thrombectomy.

Proximal Hyperdense Middle Cerebral Artery Sign is Associated with Increased Risk of Hemorrhagic Transformation after Endovascular Thrombectomy: A Multi-center Retrospective Study

“…On the contrary, Ume et al demonstrated that absent HMCAS predicts worse functional outcomes in patients with M1 occlusions treated with mechanical thrombectomy [23]. The authors attributed the difference to exclusion of patients with distal M2 occlusion, who inherently carry a more favorable outcome [23]. However, this does not explain our ndings: the good outcome at 90-day was comparable among the negative HMCAS, proximal HMCAS, and distal HMCAS groups.…”

“…Another study conducted by Mowla et al showed a similar result in patients receiving bridging therapy [17]. On the contrary, Ume et al demonstrated that absent HMCAS predicts worse functional outcomes in patients with M1 occlusions treated with mechanical thrombectomy [23]. The authors attributed the difference to exclusion of patients with distal M2 occlusion, who inherently carry a more favorable outcome [23].…”

Hyperdense Artery Sign and Clinical Outcomes After Endovascular Treatment in Acute Basilar Artery Occlusion

“…Recently, Ume et al reported that the hyperdense middle artery sign was associated with favorable outcomes and lower mortality using modern mechanical devices ( 26 ). In our study, favorable outcomes and mortality were not significantly different for patients with or without HBAS after EVT.…”

Usefulness of maximum intensity projection images of non-enhanced CT for detection of hyperdense middle cerebral artery sign in acute thromboembolic ischemic stroke

“…The results of this study indicate that the sensitivity of the hyperdense MCA sign on MIP images was significantly higher than that on averaged images. Hyperdense sign was first reported as “hyperdense MCA sign,” and the usefulness of the hyperdense sign have been reported especially in MCA [ 1 , 6 ]. Furthermore, in terms of the frequency of acute occlusions, MCA occlusions are more common than anterior cerebral artery, posterior cerebral artery, and vertebral and basilar arterial occlusions [22], and endovascular thrombectomy is strongly recommended for acute cerebral large vessel occlusion of the internal carotid artery or M1 segment of the middle cerebral artery [23].…”

“…Given that mechanical thrombectomy (MT) has become a standard therapy in acute stroke patients with the internal carotid artery or MCA occlusion, there is a growing demand for rapid access to the imaging examination that can confirm the presence of thromboembolic event. Several studies addressed the relationship between the presence of hyperdense MCA sign and prognosis after MT [ 4 – 6 ]. However, the use of the hyperdense MCA sign is limited because of the low sensitivity for the detection of thromboembolism [ 7 ].…”