Measurement of Length of Hyperdense MCA Sign in Acute
Ischemic Stroke Predicts Disappearance after IV tPA
- Author(s)
- Nandavar Shobha; Simerpreet Bal; Matthew Boyko; Eric Kroshus; Bijoy K. Menon; Rohit Bhatia; Sung-Il Sohn; Gopukumar Kumarpillai; Jayme Kosior; Michael D. Hill; Andrew M. Demchuk
- Keimyung Author(s)
- Sohn, Sung Il
- Department
- Dept. of Neurology (신경과학)
- Journal Title
- Journal of Neuroimaging
- Issued Date
- 2014
- Volume
- 24
- Issue
- 1
- Keyword
- Hyperdense MCA sign; ischemic stroke; resolution
- Abstract
- BACKGROUND
We sought to assess the hypothesis that length and volumes of middle cerebral artery
(MCA) thrombus were associated with disappearance of the hyperdense middle cerebral
artery sign (HMCAS) in acute ischemic stroke.
METHODS
This is a retrospective cohort study of acute ischemic stroke patients with MCA occlusion
admitted to the University Hospital in Canada. The length and volumes of the HMCAS
was measured on the plain CT by placing CTA images (CTA source images or MIP images)
side-by-side.
RESULTS
Seventy-six patients with acute stroke having HMCAS on noncontrast CT (NCCT) with
M1 MCA occlusion confirmed by CT angiography or digital subtraction angiography and received
tPA. The treatments received were: IV tPA 41(53.9%) and endovascular treatment ±
IV tPA 35 (46.1%). In the IV tPA group, the rate of disappearance varied depending on
the baseline HMCAS length. Short length HMCAS (<10 mm) disappeared in 6/7 (85.7%)
(P < .001). Medium length HMCAS (10-20 mm) disappeared in 9/24 (37.5%). No cases
of long length HMCAS (>20 mm) disappeared (0/10) (P = .05). Rate of disappearance of
HMCAS was found to be volume dependent (P < .002).
CONCLUSION
HMCAS length >10 mm infrequently disappears with IV tPA suggesting a potential need
for ancillary therapy in this group.
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