Hyperdense Middle Cerebral and/or Internal Carotid Arteries in Acute Ischemic Stroke: Rate, Predictive Factors and Influence on Clinical Outcome

Abstract

Background: In patients with acute stroke, the hyperdense middle cerebral artery (MCA) and internal carotid artery (ICA) signs on CT scans are markers of early ischemia, but their prognostic implications remain unclear.The aims of this prospective study were to assess: (1) the occurrence rate of hyperdense MCA and/or ICA in patients admitted for acute ischemic stroke; (2) the risk factors for hyperdense MCA and/or ICA; (3) the correlation between hyperdense MCA and/or ICA and functional outcome at 3 months. Methods: Consecutive patients admitted with ischemic stroke between 1 January 2006 and 30 June 2010 were included in this prospective single-centre cohort study. Results: 1,010 patients (mean age 71.9 years; 56.7% males) were included in the study. Among these patients, 148 (14.7%; mean age 71.2 years; 52% males) had hyperdense MCA and/or ICA. Overall, 163 patients (16.1%) had a final infarct covering more than one third of the MCA territory. Seventy-eight of 148 patients (52.7%) with hyperdense MCA and/or ICA had an infarct involving more than one third of the MCA territory compared to 85 of the 862 patients without artery hyperdensity (9.9%). At 3 months, 18 patients were lost to follow-up, 325 patients (32.8%) were disabled and 165 died (16.5%). Age (OR 1.06 for 1 added year; 95% CI 1.04–1.08), National Institute of Health Stroke Scale score for 1 added point on admission (OR 1.2; 95% CI 1.2–1.3), stroke due to atherosclerosis (OR 2.3; 95% CI 1.0–5.4), hemorrhagic transformation of the ischemic lesion (OR 2.2; 95% CI 1.0–4.9), and hyperdense MCA and/or ICA (OR 2.0; 95% CI 1.0–4.0) were associated with adverse outcome. Conclusions: In this prospective cohort of patients with acute ischemic stroke, we observed an incidence of hyperdense MCA and/or ICA arteries of about 15%; hyperdense MCA and/or ICA were associated with a final infarct involving more than one third of the MCA territory and poor functional outcome at 3 months.

Extracranial Carotid Artery Disease

“…A hyperdense middle cerebral artery CT sign has also been reported to be associated with a poor outcome. [13][14][15] We were unable to find a similar result in this study. The percentage of patients with heart disease was also higher in the group with poor outcomes, and the percentage of hypertension was higher in the group with poor outcomes as well as the group with death, but these findings did not reach significance.…”

Intravenous Thrombolysis in Unknown-Onset Stroke

“…16,17 The higher proportion of patients selected with multimodal imaging in UKO group compared with within 4.5 hours Crude and adjusted ORs in unknown onset of symptoms group compared with the ≤4.5 h group. CI indicates confidence interval; ECASS, European Cooperative Acute Stroke Study; NINDS, National Institute of Neurological Diseases and Stroke; OR, odds ratio; SICH, symptomatic intracerebral hemorrhage; and SITS-MOST, Safe Implementation of Thrombolysis in Stroke-Monitoring Study.…”

“…Of the 45 377 patients, 699/44 074 (1.6%) experienced previous stroke ≤3 months before admission, and 4876/44 668 (10.9%) had a history of stroke >3 months before admission. Baseline stroke severity as measured by the NIHSS was 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), and median door-to-needle time was 66 minutes (45-93 minutes).…”

The Location of Pretreatment Hyperdense Middle Cerebral Artery Sign Predicts the Outcome of Intraarterial Thrombectomy for Acute Stroke

“…[14][15][16] After the perimeter of the area with abnormal signal intensity was manually outlined on each DWI slice, the total volume was calculated. Intracranial arterial recanalization was determined by DSA immediately after thrombectomy using the Thrombolysis in Cerebral Infarction (TICI) grade: 17 0 = no perfusion; 1 = perfusion past the initial obstruction, but limited distal branch filling with little or slow distal perfusion; 2a = perfusion of less than ½ of the vascular distribution of the occluded artery (eg, filling and perfusion through 1 M2 division); 2b = perfusion of ½ or greater of the vascular distribution of the occluded artery (eg, filling and perfusion through 2 or more Preintervention stroke severity and imaging information NIHSS 19 13 [10][11][12][13][14][15][16][17] 20 [14][15][16][17][18][19][20][21][22][23][24] 15.5 [11][12][13][14][15][16][17][18][19] 16 [11][12][13][14][15][16][17][18][19][20] 16 [12][13]…”