Evidence map›Paper›PMID 25477225›Full record

SynthesisStroke2015

Sensitivity and specificity of the hyperdense artery sign for arterial obstruction in acute ischemic stroke.

Grant Mair, Elena V Boyd, Francesca M Chappell, Rüdiger von Kummer, Richard I Lindley, Peter Sandercock, Joanna M Wardlaw, IST-3 Collaborative Group

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Stroke, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
67citing papers in PubMed, 5 pooled it
5.8field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

67 citing papers in PubMed, 5 syntheses or guidelines pooled it, 135 citations in OpenAlex.

  1. Hyperdense sign as a predictor for successful recanalization and clinical outcome in acute ischemic stroke: A systematic review and meta-analysis.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2026
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  10. Current state and advancements of imaging in acute ischemic stroke: a practical review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
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7 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 2 countries.

Grant MairFrom the Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom (G.M., F.M.C., P.S., J.M.W.); Department of Radiology, Northwick Park Hospital, Harrow, United Kingdom (E.V.B.); Department of Neuroradiology, Dresden University Stroke Centre, University Hospital, Dresden, Germany (R.v.K.); and Westmead Hospital Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (R.I.L.).
Elena V BoydFrom the Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom (G.M., F.M.C., P.S., J.M.W.); Department of Radiology, Northwick Park Hospital, Harrow, United Kingdom (E.V.B.); Department of Neuroradiology, Dresden University Stroke Centre, University Hospital, Dresden, Germany (R.v.K.); and Westmead Hospital Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (R.I.L.).
Francesca M ChappellFrom the Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom (G.M., F.M.C., P.S., J.M.W.); Department of Radiology, Northwick Park Hospital, Harrow, United Kingdom (E.V.B.); Department of Neuroradiology, Dresden University Stroke Centre, University Hospital, Dresden, Germany (R.v.K.); and Westmead Hospital Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (R.I.L.).
Rüdiger von KummerFrom the Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom (G.M., F.M.C., P.S., J.M.W.); Department of Radiology, Northwick Park Hospital, Harrow, United Kingdom (E.V.B.); Department of Neuroradiology, Dresden University Stroke Centre, University Hospital, Dresden, Germany (R.v.K.); and Westmead Hospital Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (R.I.L.).
Richard I LindleyFrom the Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom (G.M., F.M.C., P.S., J.M.W.); Department of Radiology, Northwick Park Hospital, Harrow, United Kingdom (E.V.B.); Department of Neuroradiology, Dresden University Stroke Centre, University Hospital, Dresden, Germany (R.v.K.); and Westmead Hospital Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (R.I.L.).
Peter SandercockFrom the Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom (G.M., F.M.C., P.S., J.M.W.); Department of Radiology, Northwick Park Hospital, Harrow, United Kingdom (E.V.B.); Department of Neuroradiology, Dresden University Stroke Centre, University Hospital, Dresden, Germany (R.v.K.); and Westmead Hospital Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (R.I.L.).
Joanna M WardlawFrom the Division of Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom (G.M., F.M.C., P.S., J.M.W.); Department of Radiology, Northwick Park Hospital, Harrow, United Kingdom (E.V.B.); Department of Neuroradiology, Dresden University Stroke Centre, University Hospital, Dresden, Germany (R.v.K.); and Westmead Hospital Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (R.I.L.). joanna.wardlaw@ed.ac.uk.
IST-3 Collaborative Group
TU Dresden · DENorthwick Park Hospital · GB

Funding

Department of Health EME/08/43/52Medical Research Council G0400069Medical Research Council MC_G1002455
6 · The paper itself

Abstract

background and purposeIn acute ischemic stroke, the hyperdense artery sign (HAS) on noncontrast computed tomography (CT) is thought to represent intraluminal thrombus and, therefore, is a surrogate of arterial obstruction. We sought to assess the accuracy of HAS as a marker of arterial obstruction by thrombus.

methodsThe Third International Stroke Trial (IST-3) was a randomized controlled trial testing the use of intravenous thrombolysis for acute ischemic stroke in patients who did not clearly meet the prevailing license criteria. Some participating IST-3 centers routinely performed CT or MR angiography at baseline. One reader assessed all relevant scans independently, blinded to all other data; we checked observer reliability. We combined IST-3 data with a systematic review and meta-analysis of all studies that assessed the accuracy of HAS using angiography (any modality).

resultsIST-3 had 273 patients with baseline CT or MR angiography and was the largest study of HAS accuracy. The meta-analysis (n=902+273=1175, including IST-3) found sensitivity and specificity of HAS for arterial obstruction on angiography to be 52% and 95%, respectively. HAS was more commonly identified in proximal than distal arteries (47% versus 37%; P=0.015), and its sensitivity increased with thinner CT slices (r=-0.73; P=0.001). Neither extent of obstruction nor time after stroke influenced HAS accuracy.

conclusionsWhen present in acute ischemic stroke, HAS indicates a high likelihood of arterial obstruction, but its absence indicates only a 50/50 chance of normal arterial patency. Thin-slice CT improves sensitivity of HAS detection. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com/ISRCTN25765518. Unique identifier: ISRCTN25765518.

Indexed as

AgedAged, 80 and overArterial Occlusive DiseasesBrain IschemiaCerebral AngiographyFemaleFibrinolytic AgentsHumansMaleProspective StudiesReproducibility of ResultsSensitivity and SpecificityStrokeTissue Plasminogen ActivatorTomography, X-Ray ComputedFibrinolytic AgentsTissue Plasminogen Activatorangiographymeta-analysisstroke

Identifiers

PMID25477225
PMCPMC4338528
OpenAlexW2002874591

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.