The prognostic significance of hyperdense middle cerebral artery sign in cardioembolic stroke patients undergoing mechanical thrombectomy.

Objective: To investigate the association between the presence of the HMCAS on CT prior MT and the occurrence of poor functional outcomes and sHT in LVO patients attributed to CE and LAA etiology.

Methods: We conducted a retrospective analysis using patient data from three comprehensive stroke centers. Patients were categorized into four groups: (1) LAA with HMCAS, (2) LAA with no HMCAS, (3) cardioembolic with HMCAS, (4) cardioembolic with no HMCAS based on the presence of HMCAS and the underlying stroke etiology. We compared the 90-day modified Rankin score (mRS) and the incidence of sHT between 1 vs. 2, and 3 vs. 4.

Results: 295 patients were included, of which 93 (31.5%) exhibited HMCAS. Patients with HMCAS associated with cardioembolism (CE) had a less favorable outcome, and there was no significant difference in the rate of sHT between group 3 and 4. Conversely, there was no significant difference in prognosis and the rate of sHT between patients between group 3 and 4. In multivariate logistic regression analysis, the HMCAS independently predicted poor prognosis in patients who underwent MT due to CE (OR: 0.193, 95% CI: 0.040-0.937, p = 0.041).

Conclusion: In patients with AIS-LVO attributed to cardioembolic etiology who underwent MT, the presence of HMCAS on initial NCCT scans was found to be associated with an unfavorable outcome.

Clinical trial registration: ChiCTR 2,300,074,368.