title: Intravenous thrombolysis in stroke patients with hyperdense middle cerebral artery sign.
abstract: OBJECTIVE
  We assessed the safety and efficacy of intravenous thrombolysis (IVT) in acute stroke patients with hyperdense middle cerebral artery sign (HMCAS).
  
  
  METHODS
  Data from consecutive patients with acute (within 6 h of symptom onset) ischaemic stroke admitted between January 1999 and November 2007, in whom HMCAS was diagnosed on admission CT scan was retrospectively analysed. Seventy-one patients, admitted within the 3-h window, were treated with IVT, whilst further 42, admitted 3-6 h after symptom onset, were not. At 3-month clinical follow-up, outcome, mortality at 3 months and incidence of symptomatic intracranial haemorrhage were evaluated.
  
  
  RESULTS
  The two groups were comparable concerning age, stroke risk factors, prior antithrombotic treatment and NIHSS scores on admission. Good outcome (mRS score <or= 1) was observed in 12/71 (17%) patients who were treated with IVT and in 1/42 (2%) patients who were not (P = 0.02). IVT treatment was identified as independent predictor of good outcome (P = 0.05). Mortality was 20% in patients treated with IVT and 12% in remaining patients (P = 0.3). Symptomatic intracranial haemorrhage occurred in 1 patient of each group (2%).
  
  
  CONCLUSIONS
  These findings suggest that IVT in patients with HMCAS results in significantly better outcome, without significantly influencing mortality.
authors.affiliation: Department of Neurology, University of Zürich, Zürich, Switzerland. Dimitrios.Georgiadis@usz.ch
authors.forename: D
authors.initials: D
authors.lastname: Georgiadis
authors.forename: F
authors.initials: F
authors.lastname: Wirz
authors.forename: H-C
authors.initials: HC
authors.lastname: von Büdingen
authors.forename: P
authors.initials: P
authors.lastname: Valko
authors.forename: M
authors.initials: M
authors.lastname: Hund-Georgiadis
authors.forename: K
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: V
authors.initials: V
authors.lastname: Rousson
authors.forename: R W
authors.initials: RW
authors.lastname: Baumgartner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents