Intravenous thrombolysis in stroke patients with hyperdense middle cerebral artery sign

Background and purpose: We assessed the safety and efficacy of intravenous thrombolysis (IVT) in acute stroke patients with hyperdense middle cerebral artery sign (HMCAS). Patients and methods: Data from consecutive patients with acute (within 6 h of symptom onset) ischaemic stroke admitted between January 1999 and November 2007, in whom HMCAS was diagnosed on admission CT scan was retrospectively analysed. Seventy‐one patients, admitted within the 3‐h window, were treated with IVT, whilst further 42, admitted 3–6 h after symptom onset, were not. At 3‐month clinical follow‐up, outcome, mortality at 3 months and incidence of symptomatic intracranial haemorrhage were evaluated. Results: The two groups were comparable concerning age, stroke risk factors, prior antithrombotic treatment and NIHSS scores on admission. Good outcome (mRS score ≤ 1) was observed in 12/71 (17%) patients who were treated with IVT and in 1/42 (2%) patients who were not (P = 0.02). IVT treatment was identified as independent predictor of good outcome (P = 0.05). Mortality was 20% in patients treated with IVT and 12% in remaining patients (P = 0.3). Symptomatic intracranial haemorrhage occurred in 1 patient of each group (2%). Conclusions: These findings suggest that IVT in patients with HMCAS results in significantly better outcome, without significantly influencing mortality.