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

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1150058

DOI=10.3389/fneur.2023.1150058

ISSN=1664-2295

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. A number of studies 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 outcome (mRS) at 90 days (p = 0.698), unfavorable outcome (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 minutes 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.