Abstract
BackgroundThe hyperdense middle cerebral artery sign (HMCAS) is an early radiological marker to provide an early diagnosis and to identify ischemia. As reported, HMCAS is associated with heavy clot burden. Moreover, a heavy clot burden may cause obstruction of the orifices of arteries for leptomeningeal collateral flows and can lead to severe clinical conditions. However, the direct relationship between HMCAS and collateral flows remains unclear. Therefore, we explored the association between HMCAS and leptomeningeal collaterals in patients with acute ischemic stroke.MethodsConsecutive ischemic stroke patients were enrolled from January 2015 to April 2021. HMCAS appearance and collateral status were detected by multimodal computed tomography at admission. Logistic regression analyses helped to identify the association between HMCAS, collateral flows and stroke severity.ResultsIn 494 included patients, 180 (36.4%) presented with HMCAS. Ipsilateral collaterals were not seen or less prominent in patients with HMCAS (P < 0.001). The HMCAS appearance was significantly associated with less collaterals (odds ratio 5.17, 95% confidence interval 3.27-8.18, P < 0.001), internal carotid artery + M1/M1 occlusion, the initial stroke severity and follow-up outcomes. Subgroup analyses further confirmed HMCAS as an indicator of poor collaterals in ischemic stroke (all P values < 0.05).ConclusionsHMCAS is associated with poor leptomeningeal collaterals, the stroke severity and a poor neurological outcome. Therefore, the HMCAS appearance can act as an early warning sign for healthcare professionals to be alert for poor collateral flows and poor neurological outcomes in ischemic stroke patients with middle cerebral artery occlusion.
Highlights
The hyperdense middle cerebral artery sign (HMCAS) is an early radiological marker to provide an early diagnosis and to identify ischemia
Compared to the non-HMCAS group, the HMCAS group tended to have a history of atrial fibrillation (AF) (P < 0.001), a higher stroke severity (P < 0.001), a lower systolic blood pressure (P = 0.004), a proximal occlusion (P < 0.001), a higher proportion of endovascular treatment (P < 0.001) and poor collaterals (P < 0.001)
HMCAS is associated with the stroke severity and clinical outcomes To test the theory that the hyperdense artery sign is an indicator of a poor neurological prognosis, our study explored the association between the presence of HMCAS and the stroke severity and clinical outcomes
Summary
The hyperdense middle cerebral artery sign (HMCAS) is an early radiological marker to provide an early diagnosis and to identify ischemia. HMCAS is associated with heavy clot burden. A heavy clot burden may cause obstruction of the orifices of arteries for leptomeningeal collateral flows and can lead to severe clinical conditions. We explored the association between HMCAS and leptomeningeal collaterals in patients with acute ischemic stroke. Acute ischemic stroke is the second leading cause of death worldwide [1]. Hong et al BMC Neurology (2022) 22:51 ischemia, collaterals provide supplementary blood flow to save the brain tissue from irreversible damage [3]. Patients with poor leptomeningeal collateral flows usually have a higher severity of stroke and worse clinical outcomes in acute ischemic stroke [4, 5]. The condition of collateral blood vessels has become a key target for stroke treatment
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