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J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2533-9. doi: 10.1016/j.jstrokecerebrovasdis.2014.04.034. Epub 2014 Sep 27.

Hyperdense cerebral artery computed tomography sign is associated with stroke severity rather than stroke subtype.

Author information

1
International Clinical Research Center, Department of Neurology, St. Anne's Hospital, Brno, Czech Republic; Masaryk University, Brno, Czech Republic. Electronic address: novotna.j@centrum.cz.
2
International Clinical Research Center, St. Anne's Hospital, Brno, Czech Republic.
3
Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
4
Department of Neurology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra, Nitra, Slovakia.
5
Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Ljubljana, Slovenia.
6
Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
7
Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
8
Department of Neurology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
9
Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Vilnius, Lithuania.
10
International Clinical Research Center, Department of Neurology, St. Anne's Hospital, Brno, Czech Republic.

Abstract

BACKGROUND:

The hyperdense cerebral artery sign (HCAS) on unenhanced computed tomography (CT) in acute ischemic stroke is a valuable clinical marker, but it remains unclear if HCAS reflects clot composition or stroke etiology. Therefore, variables independently associated with HCAS were identified from a large international data set of patients treated with intravenous thrombolysis.

METHODS:

All stroke patients undergoing intravenous thrombolysis from the Safe Implementation of Treatments in Stroke-EAST (SITS-EAST) database between February 2003 and December 2011 were analyzed. A general estimating equation model accounting for within-center clustering was used to identify factors independently associated with HCAS.

RESULTS:

Of all 8878 consecutive patients, 8375 patients (94%) with available information about HCAS were included in our analysis. CT revealed HCAS in 19% of patients. Median baseline National Institutes of Health Stroke Scale (NIHSS) score was 12, mean age was 67 ± 12 years, and 3592 (43%) patients were females. HCAS was independently associated with baseline NIHSS (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.10-1.12), vessel occlusion (OR, 5.02; 95% CI, 3.31-7.63), early ischemic CT changes (OR, 1.63; 95% CI, 1.31-2.04), year (OR, 1.07; 95% CI, 1.02-1.12), and age (10-year increments; OR, .90; 95% CI, .84-.96). Cardioembolic stroke was not associated with HCAS independently of baseline NIHSS. In different centers, HCAS was reported in 0%-50% of patients.

CONCLUSIONS:

This study illustrates significant variation in detection of HCAS among stroke centers in routine clinical practice. Accounting for within-center data clustering, stroke subtype was not independently associated with HCAS; HCAS was associated with the severity of neurologic deficit.

KEYWORDS:

Dense artery sign; acute stroke; brain computed tomography; thrombolysis

[Indexed for MEDLINE]

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