title: Hyperdense cerebral artery computed tomography sign is associated with stroke severity rather than stroke subtype.
abstract: BACKGROUND
  The hyperdense cerebral artery sign (HCAS) on unenhanced computed tomography (CT) in acute ischemic stroke is a valuable clinical marker, but it remains unclear if HCAS reflects clot composition or stroke etiology. Therefore, variables independently associated with HCAS were identified from a large international data set of patients treated with intravenous thrombolysis.
  
  
  METHODS
  All stroke patients undergoing intravenous thrombolysis from the Safe Implementation of Treatments in Stroke-EAST (SITS-EAST) database between February 2003 and December 2011 were analyzed. A general estimating equation model accounting for within-center clustering was used to identify factors independently associated with HCAS.
  
  
  RESULTS
  Of all 8878 consecutive patients, 8375 patients (94%) with available information about HCAS were included in our analysis. CT revealed HCAS in 19% of patients. Median baseline National Institutes of Health Stroke Scale (NIHSS) score was 12, mean age was 67 ± 12 years, and 3592 (43%) patients were females. HCAS was independently associated with baseline NIHSS (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.10-1.12), vessel occlusion (OR, 5.02; 95% CI, 3.31-7.63), early ischemic CT changes (OR, 1.63; 95% CI, 1.31-2.04), year (OR, 1.07; 95% CI, 1.02-1.12), and age (10-year increments; OR, .90; 95% CI, .84-.96). Cardioembolic stroke was not associated with HCAS independently of baseline NIHSS. In different centers, HCAS was reported in 0%-50% of patients.
  
  
  CONCLUSIONS
  This study illustrates significant variation in detection of HCAS among stroke centers in routine clinical practice. Accounting for within-center data clustering, stroke subtype was not independently associated with HCAS; HCAS was associated with the severity of neurologic deficit.
authors.affiliation: International Clinical Research Center, Department of Neurology, St. Anne's Hospital, Brno, Czech Republic; Masaryk University, Brno, Czech Republic. Electronic address: novotna.j@centrum.cz.
authors.forename: Jana
authors.initials: J
authors.lastname: Novotná
authors.affiliation: International Clinical Research Center, St. Anne's Hospital, Brno, Czech Republic.
authors.forename: Pavla
authors.initials: P
authors.lastname: Kadlecová
authors.affiliation: Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Czlonkowska
authors.affiliation: Department of Neurology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra, Nitra, Slovakia.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Brozman
authors.affiliation: Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Ljubljana, Slovenia.
authors.forename: Viktor
authors.initials: V
authors.lastname: Švigelj
authors.affiliation: Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Csiba
authors.affiliation: Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
authors.forename: Janika
authors.initials: J
authors.lastname: Kõrv
authors.affiliation: Department of Neurology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
authors.forename: Vida
authors.initials: V
authors.lastname: Demarin
authors.affiliation: Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Vilnius, Lithuania.
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Vilionskis
authors.affiliation: International Clinical Research Center, Department of Neurology, St. Anne's Hospital, Brno, Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulík
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Dense artery sign; acute stroke; brain computed tomography; thrombolysis