An anterior temporal artery arising from M1 MCA was present in 20/102 (20%). Eighteen of 20 (90%) patients with this sign survived at 3 months (mRS 0-5) when compared to 66/82 (80.4%) patients without the sign (odds ratio 2.2 CI95 .5-10.4). The sign has a sensitivity of 21% (CI95 .13-.25) but specificity of 89% (CI95 .64-.98) in predicting survival at 3 months. Positive predictive value was 90% with likelihood ratio of 1.9 (CI95 .9-7.6). Presence of prominent anterior temporal artery in M1-MCA occlusions on CTA identifies a group of patients with reduced case fatality. The mechanism is likely related to a reduced chance of malignant
cerebral edema. J Neuroimaging 2012;22:145-148. “
“We sought selleck compound 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. 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. Seventy-six patients with acute stroke having HMCAS on noncontrast CT (NCCT) with M1 MCA occlusion confirmed https://www.selleckchem.com/products/Dasatinib.html 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 BCKDHA 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). HMCAS length >10 mm infrequently disappears with IV tPA suggesting a potential need for ancillary
therapy in this group. Hyperdense middle cerebral artery sign (HMCAS) is noted in 19-40% of patients with middle cerebral artery (MCA) territory infarcts.[1-3] The HMCAS was a predictor of poor outcome in patients treated with tPA in the ECASS I study. The resolution of the hyperdense sign represents recanalization. Disappearance is associated with early clinical improvement and favorable outcome. Endovascular treatment has been associated with greater rates of immediate recanalization compared to intravenous tPA alone. It seems logical that shorter the length and smaller the volumes of HMCAS, the more likely recanalization will occur. We assessed this hypothesis among patients with proven acute M1-MCA occlusion. This is a retrospective cohort study of patients with M1-MCA occlusion and acute ischemic strokes who presented to the Foothills Medical Center, Calgary between March 2002 and December 2009 selected from our CTA database.