Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow.
OBJECTIVE
To evaluate the association between the hyperdense middle cerebral artery sign (HMCAS) and the functional outcome on one hand, and different predictors such as the National Institutes of Health Stroke Scale (NIHSS), infarct size, ASPECTS Score, intracerebral hemorrhage, and mortality on the other hand.


METHODS
Retrospective analysis of 120 patients with MCA-stroke treated with intravenous thrombolysis. We tested the association between HMCAS and NIHSS, infarct volume, ASPECTS, outcome, level of consciousness, different recorded time intervals, and the day/time of admission.


RESULTS
Seventy-four percentage of patients treated with thrombolysis developed cerebral infarction. All patients with HMCAS (n = 39) sustained infarction and only 31% showed favorable outcome compared with 62% and 60%, respectively among patients without HMCAS (P < 0.001 and P = 0.002). There was statistically significant association between functional outcome and HMCAS (P = 0.002), infarct volume, NIHSS, and ASPECTS (P < 0.001). The time to treatment was 12 min shorter in patients who developed infarction (P = 0.037). Independent predictors for outcome were NIHSS and the occurrence of cerebral infarction on computed tomography for the whole study population, and infarct volume for patients who sustained cerebral infarction.


CONCLUSIONS
Despite optimal workflow, patients with HMCAS showed poor outcome after intravenous thrombolysis. The results emphasize the urgent need for more effective revascularization therapies and neuroprotective treatment in this subgroup of stroke patients.
Faculty of Medicine, University of Lund, Division of Neuroradiology, Department of Radiology, Malmö University Hospital, Malmö, Sweden. kasim.abul-kasim@med.lu.se
K
K
Abul-Kasim
M
M
Brizzi
J
J
Petersson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000401:mortality; D004185:Disability Evaluation; D005260:Female; D006785:Hospitals, University; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden; D015912:Thrombolytic Therapy; D013996:Time and Motion Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D036542:Tomography, Spiral Computed; D014057:Tomography, X-Ray Computed; D057188:Workflow
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator