{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T19:17:09Z","timestamp":1778786229619,"version":"3.51.4"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[1999,4]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014The hyperdense middle cerebral artery sign (HMCAS) is a marker of thrombus in the middle cerebral artery. The aim of our study was to find out the frequency of the HMCAS, its association with initial neurological severity and early parenchymal ischemic changes on CT, its relevance to clinical outcome, and the efficacy of intravenous recombinant tissue plasminogen activator (rtPA) in patients with the HMCAS.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014Secondary analysis of the data from 620 patients who received either rtPA or placebo in the European Cooperative Acute Stroke Study I (ECASS I), a double-blind, randomized, multicenter trial. The baseline CT scans were obtained within 6 hours from the onset of symptoms. Functional and neurological outcomes were assessed using the modified Rankin Scale and the Scandinavian Stroke Scale at day 90.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014We found an HMCAS in 107 patients(17.7%). The initial neurological deficit was more severe in patients with the HMCAS than in those lacking this sign (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.0001). Early cerebral edema and mass effect were also more common in patients with the HMCAS (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.0001). The HMCAS was related to the risk of poor functional outcome (grade of 3 to 6 on the modified Rankin Scale) on univariate analysis: 90 patients (84%) with the HMCAS and 310 patients (62%) lacking this sign were dependent or dead at day 90 (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.0001). However, this association was no longer significant in a logistic model accounting for the effect of age, sex, treatment with rtPA, initial severity of neurological deficit and early parenchymal ischemic changes on CT. Patients with the HMCAS who were given rtPA had better neurological recovery than those who received placebo (\n            <jats:italic>P<\/jats:italic>\n            =0.0297).\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014The HMCAS is associated with severe brain ischemia and poor functional outcome. However, it has no significant independent prognostic value when accounting for the effect of initial severity of neurological deficit and of early parenchymal ischemic changes on CT. Patients with the HMCAS may benefit from intravenous rtPA.\n          <\/jats:p>","DOI":"10.1161\/01.str.30.4.769","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:10:52Z","timestamp":1308341452000},"page":"769-772","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":105,"title":["Association of Hyperdense Middle Cerebral Artery Sign With Clinical Outcome in Patients Treated With Tissue Plasminogen Activator"],"prefix":"10.1161","volume":"30","author":[{"given":"Claude","family":"Manelfe","sequence":"first","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Larrue","sequence":"additional","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ru\u0308diger","family":"von Kummer","sequence":"additional","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Bozzao","sequence":"additional","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Ringleb","sequence":"additional","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Bastianello","sequence":"additional","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franc\u0327oise","family":"Iweins","sequence":"additional","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Lesaffre","sequence":"additional","affiliation":[{"name":"From the Departments of Neuroradiology (C.M.) and Neurology (V.L.), University of Toulouse, France; the Department of Neuroradiology (R. v K.), University of Dresden, Germany; the Department of Neuroradiology (L.B., S.B.), University of Rome, Italy; the Department of Neurology (P.R.), University of Heidelberg, Germany; and the Biostatistical Center for Clinical Trials (F.I., E.L.), University of Leuven, Belgium."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.14.5.6658961"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00344173"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00588219"},{"key":"e_1_3_2_4_2","first-page":"3","volume":"14","year":"1993","unstructured":"Wolpert SM, Bruckmann H, Greenlee R, Wechsler L, Pessin MS, del Zoppo GJ, and the rt-PA Acute Stroke Study Group. 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