Functional and technical outcomes in acute ischemic stroke patients with hyperdense middle cerebral artery sign treated with endovascular thrombectomy

Yimin Chen; Francesco Diana; Mohammad Mofatteh; Sijie Zhou; Juanmei Chen; Zhou Huang; Weijuan Wu; Yajie Yang; Zhiyi Zeng; Weijian Zhang; Ziqi Ouyang; Thanh N Nguyen; Shuiquan Yang; José Fidel Baizabal-Carvallo; Xuxing Liao

doi:10.3389/fneur.2023.1150058

Functional and technical outcomes in acute ischemic stroke patients with hyperdense middle cerebral artery sign treated with endovascular thrombectomy

Front Neurol. 2023 May 25:14:1150058. doi: 10.3389/fneur.2023.1150058. eCollection 2023.

Authors

Yimin Chen¹, Francesco Diana², Mohammad Mofatteh³, Sijie Zhou⁴, Juanmei Chen⁵, Zhou Huang⁶, Weijuan Wu¹, Yajie Yang⁷, Zhiyi Zeng⁸, Weijian Zhang⁴, Ziqi Ouyang⁹, Thanh N Nguyen¹⁰, Shuiquan Yang¹, José Fidel Baizabal-Carvallo^{11

12}, Xuxing Liao^{4

9}

Affiliations

¹ Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China.
² Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
³ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
⁴ Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong, China.
⁵ The Second Clinical College, Guangzhou Medical University, Guangzhou, China.
⁶ Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China.
⁷ The First School of Clinical Medicine, Southern Medical University, Foshan, China.
⁸ Department of Scientific Research and Education, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China.
⁹ Department of Neurosurgery, Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China.
¹⁰ Department of Neurology and Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
¹¹ Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
¹² Department of Sciences and Engineering, University of Guanajuato, León, Mexico.

Abstract

Background and objective: The hyperdense middle cerebral artery sign (HMCAS) is observed in a proportion of patients with acute ischemic stroke (AIS). This sign reflects the presence of an intravascular thrombus rich in red blood cells. Several studies have demonstrated that HMCAS increases the risk of poor outcomes in AIS patients treated with IV thrombolysis or no reperfusion therapy; however, whether HMCAS predicts a poor outcome in patients treated with endovascular thrombectomy (EVT) is less clear. We aimed to evaluate the functional outcome by the modified Rankin scale (mRS) at 90 days and technical challenges in patients with HMCAS undergoing EVT.

Methods: We studied 143 consecutive AIS patients with middle cerebral artery M1 segment or internal carotid artery + M1 occlusions who underwent EVT.

Results: There were 73 patients (51%) with HMCAS. Patients with HMCAS had a higher frequency of cardioembolic stroke (p = 0.038); otherwise, no other baseline difference was observed. No differences in functional outcomes (mRS) at 90 days (p = 0.698), unfavorable outcomes (mRS > 2) (p = 0.929), frequency of symptomatic intracranial hemorrhage (p = 0.924), and mortality (mRS-6) (p = 0.736) were observed between patients with and without HMCAS. In patients with HMCAS, EVT procedures were 9 min longer, requiring a higher number of passes (p = 0.073); however, optimal recanalization scores (modified thrombolysis in cerebral infarction: 2b-3) were equally achieved by both groups.

Conclusion: Patients with HMCAS treated with EVT do not have a worse outcome at 3 months compared with no-HMCAS patients. Patients with HMCAS required a greater number of thrombus passes and longer procedure times.

Keywords: endovascular; hyperdense artery; imaging; ischemic stroke; thrombectomy.