Abstract
The aim of our study was to compare the rapid neurological improvement after intravenous recombinant tissue-type plasminogen activator (rtPA) in patients with proximal hyperdense middle cerebral artery sign (p-HMCAS) to those without the sign and those with the distal hyperdense middle cerebral artery sign (d-HMCAS). Admission and 24 hour non-contrast CT scans of 120 patients with middle cerebral artery (MCA) territory stroke who were treated with intravenous rtPA were assessed for the presence of p-HMCAS and d-HMCAS. The sign was classified according to the site of occlusion. Rapid neurological improvement was defined as ≥50% improvement in the NIHSS score at 24 hours after thrombolysis. Rapid neurological recovery after thrombolysis was assessed and compared between the subgroups. Rapid neurological recovery was less common in the pooled group of patients with either p-HMCAS or d-HMCAS than those without the sign (p<0.01). Patients with p-HMCAS were less likely to have rapid neurological recovery than those with d-HMCAS (p<0.01). However, there was no difference in early neurological recovery between patients with d-HMCAS and those without any hyperdense sign. Our study showed that poor neurological recovery post rtPA was confined to p-HMCAS and not to d-HMCAS, indicating that these signs have quite different prognostic significance.
Highlights
The hyperdense artery sign on admission non-contrast CT is a well established early marker of thromboembolic arterial occlusion [1,2]
Hyperdense artery sign can be categorized as proximal hyperdense middle cerebral artery sign (p-HMCAS) and distal hyperdense middle cerebral artery sign (d-HMCAS) on non-contrast CT according to the site of occlusion [4,5]
Of the 148 patients with middle cerebral artery territory stroke who were treated with intravenous recombinant tissue plasminogen activator (rtPA) between Oct 2007 and Oct 2010, 120 patients were eligible for the final analysis
Summary
The hyperdense artery sign on admission non-contrast CT is a well established early marker of thromboembolic arterial occlusion [1,2]. Hyperdense artery sign can be categorized as proximal hyperdense middle cerebral artery sign (p-HMCAS) and distal hyperdense middle cerebral artery sign (d-HMCAS) on non-contrast CT according to the site of occlusion [4,5]. It is well-established that thrombolytic treatment within 4.5 hours saves ischemic tissue at risk and is associated with improved neurological outcomes in patients with acute ischemic stroke [6]. Rapid neurological improvement within 24 hours after treatment with intravenous recombinant tissue plasminogen activator (rtPA) has been reported in MCA territory stroke patients [7,8]. The efficacy of thrombolysis in patients with hyperdense artery signs remains unclear
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
