ArticleStroke and vascular neurology2021
Hyperdense artery sign, symptomatic infarct swelling and effect of alteplase in acute ischaemic stroke.
Article in Stroke and vascular neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 11 citations in OpenAlex.
- Analysis of a clot-based combined radiomics model for predicting embolic etiology in acute ischemic stroke patients.European journal of radiology open · 2025Article
- Accurate forecasting in acute ischemic stroke: innovative nomogram models for early neurological deterioration and 90-day prognosis outcomes following intravenous thrombolysis.European journal of medical research · 2025Article
- Clinical course, causes of worsening, and outcomes of severe ischemic stroke: A prospective multicenter cohort study.Chinese medical journal · 2025Article
- Segmentation of the Hyperdense Artery Sign on Noncontrast CT in Ischemic Stroke Using Artificial Intelligence.Journal of clinical neurology (Seoul, Korea) · 2025Article
- Noninvasive imaging biomarker reveals invisible microscopic variation in acute ischaemic stroke (≤ 24 h): a multicentre retrospective study.Scientific reports · 2025Article
- Predicting the emergence of malignant brain oedema in acute ischaemic stroke: a prospective multicentre study with development and validation of predictive modelling.EClinicalMedicine · 2023Article
- Association between serum NLRP3 and malignant brain edema in patients with acute ischemic stroke.BMC neurology · 2021Article
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Authors and funding
16 authors at 10 institutions in 6 countries.
Funding
Abstract
backgroundAlteplase improves functional outcomes of patients with acute ischaemic stroke, but its effects on symptomatic infarct swelling, an adverse complication of stroke and the influence of CT hyperdense artery sign (HAS) are unclear. This substudy of the Third International Stroke Trial aimed to investigate the association between HAS and symptomatic infarct swelling and effect of intravenous alteplase on this association.
methodsWe included stroke patients whose prerandomisation scan was non-contrast CT. Raters, masked to clinical information, assessed baseline (prerandomisation) and follow-up (24-48 hours postrandomisation) CT scans for HAS, defined as an intracranial artery appearing denser than contralateral arteries. Symptomatic infarct swelling was defined as clinically significant neurological deterioration ≤7 days after stroke with radiological evidence of midline shift, effacement of basal cisterns or uncal herniation.
resultsAmong 2961 patients, HAS presence at baseline was associated with higher risk of symptomatic infarct swelling (OR 2.21; 95% CI 1.42 to 3.44). Alteplase increased the risk of swelling (OR 1.69; 95% CI 1.11 to 2.57), with no difference between patients with and those without baseline HAS (p=0.49). In patients with baseline HAS, alteplase reduced the proportion with HAS at follow-up (OR 0.67; 95% CI 0.50 to 0.91), where HAS disappearance was associated with reduced risk of swelling (OR 0.25, 95% CI 0.14 to 0.47).
conclusionAlthough alteplase was associated with increased risk of symptomatic infarct swelling in patients with or without baseline HAS, it was also associated with accelerated clearance of HAS, which in return reduced swelling, providing further mechanistic insights to underpin the benefits of alteplase.
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