Does Hyperdense Middle Cerebral Artery Sign Predict the Prognosis of Patients Undergoing Emergency Endovascular...

Hyperdense Middle Cerebral Artery (HMCAS) is one of the early CT signs of acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Whether HMCAS is an accurate predictor of functional outcomes in LVO-AIS patients still needs to be further studied. This study aimed to evaluate the prognostic value of the HMCAS for functional outcomes in patients with LVO-AIS receiving emergency endovascular treatment (EVT), with or without prior intravenous thrombolysis (IVT).

The clinical and imaging data in LVO-AIS patients who underwent EVT with or without IVT were retrospectively analyzed. The patients were divided into HMCAS+ group and HMCAS- group according to the presence or absence of HMCAS on initial CT. The endpoint was the 90-day Modified Rankin Scale (mRS), and multivariate logistic ordinal regression was used to determine the association between the presence of HMCAS and 90-day mRS.

A total of 173 LVO-AIS patients were recruited for this study, with 69 (39.88%) in the HMCAS+ group and 104 (60.12%) in the HMCAS- group. The mean age of the participants was 68.98±13.529 years, with 89 (49.71%) being male and 67 (38.73%) receiving IVT. Multivariate logistic regression of the presence of HMCAS (OR, 1.240 95% CI, 0.693-2.219 P =0.511) was not significantly associated with the 90-day mRS score.

The HMCAS typically occurs in cases with red blood cell (RBC)-dominant thrombi or thrombi exhibiting a balanced composition of RBCs and fibrin. However, in patients undergoing EVT, thrombus removal is achieved through physical extraction, diminishing the influence of thrombus composition on procedural success.

HMCAS may not be a predictor of 90-day mRS in LVO-AIS patients undergoing EVT. However HMCAS+ group patients had higher stroke severity before IVT and EVT. In the era of EVT, the factors affecting the prognosis of LVO-AIS may be different from those of the past.