title: 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.
authors.affiliation: Stroke Unit, Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy. mpaciaroni@med.unipg.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Piero
authors.initials: P
authors.lastname: Floridi
authors.forename: Andrea
authors.initials: A
authors.lastname: Alberti
authors.forename: Monica
authors.initials: M
authors.lastname: Acciarresi
authors.forename: Michele
authors.initials: M
authors.lastname: Venti
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Alagia
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiacca
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Gallina
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guercini
authors.forename: Roberto
authors.initials: R
authors.lastname: Pantaleoni
authors.forename: Francesca
authors.initials: F
authors.lastname: Leone
authors.forename: Alessio
authors.initials: A
authors.lastname: Pieroni
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000534:rehabilitation; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014057:Tomography, X-Ray Computed