Hyperdense middle cerebral artery sign: Can it be used to select intra-arterial versus intravenous thrombolysis in acute ischemic stroke?

Pinky Agarwal, Sanjeev Kumar, Subramanian Hariharan, Noam Eshkar, Piero Verro, Barry Cohen, Souvik Sen

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Stroke patients with a hyperdense middle cerebral artery sign (HMCAS) may respond less favorably to intravenous (IV) thrombolysis. Objective: To compare outcomes of patients with and without early CT findings treated with IV versus intra-arterial (IA) recombinant tissue plasminogen activator (rtPA). Methods: Initial and 24-hour CT scans of the head were evaluated in 83 consecutive stroke patients (66 on IV rtPA, 17 on IA rtPA). Time permitting, a CT angiogram was performed immediately after the initial CT scan to ascertain major cerebral artery occlusion. Demographics and etiological stroke subtype, times to thrombolysis and CT scan, base-line (prethrombolysis) and 24-hour National Institutes of Health stroke scale (NIHSS) score, discharge NIHSS score and 90-day modified Rankin scale (mRS) were recorded. The initial CT of these patients was examined for early signs of stroke. The 24-hour scan was reviewed for the presence of infarct, hemorrhage and persistence of HCMAS. Results: A favorable outcome, indicated by a significant improvement in the discharge NIHSS score, was noted with IA rtPA, irrespective of the presence (p = 0.001) or absence (p = 0.01) of HCMAS. A less favorable outcome in discharge NIHSS score was noted with IV rtPA in patients with HCMAS (p = not significant) than those without the sign (p < 0.001). A similar proportion of patients with HCMAS exhibited a neurological improvement at 24 h as those without the sign in the IA rtPA group (p = 0.9). However, a smaller proportion of patients with HCMAS exhibited a neurological improvement at 24 h than those without the sign in the IV rtPA group (p = 0.005). The results were similar using 90-day mRS ≤1 as an indicator of significant persistent improvement (p = 1.0 for IA rtPA and 0.04 for IV rtPA group). Conclusions: In a small sample, patients with HMCAS appeared to respond better to IA than IV rtPA.

Original languageEnglish (US)
Pages (from-to)182-190
Number of pages9
JournalCerebrovascular Diseases
Volume17
Issue number2-3
DOIs
StatePublished - 2004
Externally publishedYes

Fingerprint

Middle Cerebral Artery
Tissue Plasminogen Activator
Stroke
National Institutes of Health (U.S.)
Cerebral Arteries
Angiography
Head
Demography
Hemorrhage

Keywords

  • Acute ischemic stroke
  • Hyperdense middle cerebral artery sign
  • Intra-arterial thrombolysis
  • Intravenous thrombolysis
  • M2 'dot' sign
  • Recanalization

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Hyperdense middle cerebral artery sign : Can it be used to select intra-arterial versus intravenous thrombolysis in acute ischemic stroke? / Agarwal, Pinky; Kumar, Sanjeev; Hariharan, Subramanian; Eshkar, Noam; Verro, Piero; Cohen, Barry; Sen, Souvik.

In: Cerebrovascular Diseases, Vol. 17, No. 2-3, 2004, p. 182-190.

Research output: Contribution to journalArticle

Agarwal, Pinky ; Kumar, Sanjeev ; Hariharan, Subramanian ; Eshkar, Noam ; Verro, Piero ; Cohen, Barry ; Sen, Souvik. / Hyperdense middle cerebral artery sign : Can it be used to select intra-arterial versus intravenous thrombolysis in acute ischemic stroke?. In: Cerebrovascular Diseases. 2004 ; Vol. 17, No. 2-3. pp. 182-190.
@article{ec59a2056ee743799f21b95144f1112b,
title = "Hyperdense middle cerebral artery sign: Can it be used to select intra-arterial versus intravenous thrombolysis in acute ischemic stroke?",
abstract = "Background: Stroke patients with a hyperdense middle cerebral artery sign (HMCAS) may respond less favorably to intravenous (IV) thrombolysis. Objective: To compare outcomes of patients with and without early CT findings treated with IV versus intra-arterial (IA) recombinant tissue plasminogen activator (rtPA). Methods: Initial and 24-hour CT scans of the head were evaluated in 83 consecutive stroke patients (66 on IV rtPA, 17 on IA rtPA). Time permitting, a CT angiogram was performed immediately after the initial CT scan to ascertain major cerebral artery occlusion. Demographics and etiological stroke subtype, times to thrombolysis and CT scan, base-line (prethrombolysis) and 24-hour National Institutes of Health stroke scale (NIHSS) score, discharge NIHSS score and 90-day modified Rankin scale (mRS) were recorded. The initial CT of these patients was examined for early signs of stroke. The 24-hour scan was reviewed for the presence of infarct, hemorrhage and persistence of HCMAS. Results: A favorable outcome, indicated by a significant improvement in the discharge NIHSS score, was noted with IA rtPA, irrespective of the presence (p = 0.001) or absence (p = 0.01) of HCMAS. A less favorable outcome in discharge NIHSS score was noted with IV rtPA in patients with HCMAS (p = not significant) than those without the sign (p < 0.001). A similar proportion of patients with HCMAS exhibited a neurological improvement at 24 h as those without the sign in the IA rtPA group (p = 0.9). However, a smaller proportion of patients with HCMAS exhibited a neurological improvement at 24 h than those without the sign in the IV rtPA group (p = 0.005). The results were similar using 90-day mRS ≤1 as an indicator of significant persistent improvement (p = 1.0 for IA rtPA and 0.04 for IV rtPA group). Conclusions: In a small sample, patients with HMCAS appeared to respond better to IA than IV rtPA.",
keywords = "Acute ischemic stroke, Hyperdense middle cerebral artery sign, Intra-arterial thrombolysis, Intravenous thrombolysis, M2 'dot' sign, Recanalization",
author = "Pinky Agarwal and Sanjeev Kumar and Subramanian Hariharan and Noam Eshkar and Piero Verro and Barry Cohen and Souvik Sen",
year = "2004",
doi = "10.1159/000075789",
language = "English (US)",
volume = "17",
pages = "182--190",
journal = "Cerebrovascular Diseases",
issn = "1015-9770",
publisher = "S. Karger AG",
number = "2-3",

}

TY - JOUR

T1 - Hyperdense middle cerebral artery sign

T2 - Can it be used to select intra-arterial versus intravenous thrombolysis in acute ischemic stroke?

AU - Agarwal, Pinky

AU - Kumar, Sanjeev

AU - Hariharan, Subramanian

AU - Eshkar, Noam

AU - Verro, Piero

AU - Cohen, Barry

AU - Sen, Souvik

PY - 2004

Y1 - 2004

N2 - Background: Stroke patients with a hyperdense middle cerebral artery sign (HMCAS) may respond less favorably to intravenous (IV) thrombolysis. Objective: To compare outcomes of patients with and without early CT findings treated with IV versus intra-arterial (IA) recombinant tissue plasminogen activator (rtPA). Methods: Initial and 24-hour CT scans of the head were evaluated in 83 consecutive stroke patients (66 on IV rtPA, 17 on IA rtPA). Time permitting, a CT angiogram was performed immediately after the initial CT scan to ascertain major cerebral artery occlusion. Demographics and etiological stroke subtype, times to thrombolysis and CT scan, base-line (prethrombolysis) and 24-hour National Institutes of Health stroke scale (NIHSS) score, discharge NIHSS score and 90-day modified Rankin scale (mRS) were recorded. The initial CT of these patients was examined for early signs of stroke. The 24-hour scan was reviewed for the presence of infarct, hemorrhage and persistence of HCMAS. Results: A favorable outcome, indicated by a significant improvement in the discharge NIHSS score, was noted with IA rtPA, irrespective of the presence (p = 0.001) or absence (p = 0.01) of HCMAS. A less favorable outcome in discharge NIHSS score was noted with IV rtPA in patients with HCMAS (p = not significant) than those without the sign (p < 0.001). A similar proportion of patients with HCMAS exhibited a neurological improvement at 24 h as those without the sign in the IA rtPA group (p = 0.9). However, a smaller proportion of patients with HCMAS exhibited a neurological improvement at 24 h than those without the sign in the IV rtPA group (p = 0.005). The results were similar using 90-day mRS ≤1 as an indicator of significant persistent improvement (p = 1.0 for IA rtPA and 0.04 for IV rtPA group). Conclusions: In a small sample, patients with HMCAS appeared to respond better to IA than IV rtPA.

AB - Background: Stroke patients with a hyperdense middle cerebral artery sign (HMCAS) may respond less favorably to intravenous (IV) thrombolysis. Objective: To compare outcomes of patients with and without early CT findings treated with IV versus intra-arterial (IA) recombinant tissue plasminogen activator (rtPA). Methods: Initial and 24-hour CT scans of the head were evaluated in 83 consecutive stroke patients (66 on IV rtPA, 17 on IA rtPA). Time permitting, a CT angiogram was performed immediately after the initial CT scan to ascertain major cerebral artery occlusion. Demographics and etiological stroke subtype, times to thrombolysis and CT scan, base-line (prethrombolysis) and 24-hour National Institutes of Health stroke scale (NIHSS) score, discharge NIHSS score and 90-day modified Rankin scale (mRS) were recorded. The initial CT of these patients was examined for early signs of stroke. The 24-hour scan was reviewed for the presence of infarct, hemorrhage and persistence of HCMAS. Results: A favorable outcome, indicated by a significant improvement in the discharge NIHSS score, was noted with IA rtPA, irrespective of the presence (p = 0.001) or absence (p = 0.01) of HCMAS. A less favorable outcome in discharge NIHSS score was noted with IV rtPA in patients with HCMAS (p = not significant) than those without the sign (p < 0.001). A similar proportion of patients with HCMAS exhibited a neurological improvement at 24 h as those without the sign in the IA rtPA group (p = 0.9). However, a smaller proportion of patients with HCMAS exhibited a neurological improvement at 24 h than those without the sign in the IV rtPA group (p = 0.005). The results were similar using 90-day mRS ≤1 as an indicator of significant persistent improvement (p = 1.0 for IA rtPA and 0.04 for IV rtPA group). Conclusions: In a small sample, patients with HMCAS appeared to respond better to IA than IV rtPA.

KW - Acute ischemic stroke

KW - Hyperdense middle cerebral artery sign

KW - Intra-arterial thrombolysis

KW - Intravenous thrombolysis

KW - M2 'dot' sign

KW - Recanalization

UR - http://www.scopus.com/inward/record.url?scp=1942531429&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1942531429&partnerID=8YFLogxK

U2 - 10.1159/000075789

DO - 10.1159/000075789

M3 - Article

C2 - 14707420

AN - SCOPUS:1942531429

VL - 17

SP - 182

EP - 190

JO - Cerebrovascular Diseases

JF - Cerebrovascular Diseases

SN - 1015-9770

IS - 2-3

ER -