Background and purpose

Combining intra-arterial mechanical thrombectomy (IAMT) and intravenous thrombolysis (IVT) has shown to have an excellent recanalization rate and better clinical outcome in acute ischemic stroke (AIS) patients. Hyperdense middle cerebral artery sign (HMCAS) on pretreatment non-contrast head CT scan of AIS patients is one of the early ischemic radiological findings in middle cerebral artery territory AIS. We aimed to evaluate whether the presence of HMCAS predicts the outcome of AIS patients receiving combination therapy with IAMT and IVT.

Methods

We retrospectively reviewed medical records and cerebrovascular images of the patients treated with IAMT and IVT for AIS in our center. Patients with occlusion in the terminal internal carotid artery or middle cerebral artery on pretreatment CT angiogram of the head were included. Clinical outcome was compared between subjects with HMCAS and those without. Modified Rankin Score (mRS) and symptomatic intracranial hemorrhage (sICH) were used as measures of efficacy and safety, respectively.

Results

Of 93 patients, 46 (49%) had HMCAS on their initial head CT scan. Both groups had comparable baseline characteristics and stroke severity. After adjusting for age, NIHSS score, time from symptom onset to starting IVT, and history of diabetes mellitus in multivariate logistic regression analysis, there was no difference in terms of a poor outcome (mRS >2) (OR = 0.5 [CI 0.2–1.4], p = 0.188) or rate of sICH (OR = 3.3 [CI 0.6–19.0], p = 0.190) between the two groups.

Conclusions

HMCAS is not a predictor of poor outcome in AIS patients receiving combination therapy with IAMT and IVT and does not affect treatment safety.

中文翻译：

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急性脑卒中患者大脑中动脉高密度征及机械取栓联合静脉溶栓治疗的反应

背景和目的

结合动脉内机械取栓 (IAMT) 和静脉溶栓 (IVT) 已显示在急性缺血性中风 (AIS) 患者中具有出色的再通率和更好的临床结果。AIS患者治疗前非对比头颅CT扫描中大脑中动脉高密度征（HMCAS）是大脑中动脉区AIS早期缺血影像学表现之一。我们旨在评估 HMCAS 的存在是否可以预测接受 IAMT 和 IVT 联合治疗的 AIS 患者的结果。

方法

我们回顾性地审查了我们中心接受 IAMT 和 IVT 治疗 AIS 的患者的病历和脑血管图像。包括治疗前头部CT血管造影显示颈内动脉或大脑中动脉闭塞的患者。比较有 HMCAS 的受试者和没有 HMCAS 的受试者的临床结果。改良的 Rankin 评分 (mRS) 和症状性颅内出血 (sICH) 分别用作疗效和安全性的衡量标准。

结果

在 93 名患者中，46 名 (49%) 在最初的头部 CT 扫描中有 HMCAS。两组具有可比的基线特征和中风严重程度。在对年龄、NIHSS 评分、从症状出现到开始 IVT 的时间以及多变量逻辑回归分析中的糖尿病病史进行调整后，在不良结局（mRS > 2）方面没有差异（OR = 0.5 [CI 0.2– 1.4]，p  = 0.188）或两组之间的 sICH 率（OR = 3.3 [CI 0.6–19.0]，p  = 0.190）。

结论

HMCAS 不是接受 IAMT 和 IVT 联合治疗的 AIS 患者预后不良的预测因素，也不影响治疗安全性。