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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

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



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.


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.


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.


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.


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

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