Jana Novotná1, Pavla Kadlecová2, Anna Czlonkowska3, Miroslav Brozman4, Viktor Švigelj5, Laszlo Csiba6, Janika Kõrv7, Vida Demarin8, Aleksandras Vilionskis9, Robert Mikulík10. 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.
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 strokepatients 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.
Authors: Laura Strada; Jonathan Y Streifler; Bruno Del Sette; Matteo Puntoni; Antonio Castaldi; Daria Bianchini; Massimo Del Sette Journal: Neurol Sci Date: 2017-07-19 Impact factor: 3.307
Authors: Grant Mair; Rüdiger von Kummer; Zoe Morris; Anders von Heijne; Nick Bradey; Lesley Cala; André Peeters; Andrew J Farrall; Alessandro Adami; Gillian Potter; Geoff Cohen; Peter A G Sandercock; Richard I Lindley; Joanna M Wardlaw Journal: Neurology Date: 2015-12-09 Impact factor: 9.910
Authors: Grant Mair; Rüdiger von Kummer; Richard I Lindley; Peter A G Sandercock; Joanna M Wardlaw Journal: PLoS One Date: 2015-12-23 Impact factor: 3.240