RT Journal Article
SR Electronic
T1 Hyperdense artery sign, symptomatic infarct swelling and effect of alteplase in acute ischaemic stroke
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 238
OP 243
DO 10.1136/svn-2020-000569
VO 6
IS 2
A1 Wu, Simiao
A1 Mair, Grant
A1 Cohen, Geoff
A1 Morris, Zoe
A1 von Heijne, Anders
A1 Bradey, Nick
A1 Cala, Lesley
A1 Peeters, Andre
A1 Farrall, Andrew J
A1 Adami, Alessandro
A1 Potter, Gillian
A1 Liu, Ming
A1 Lindley, Richard I
A1 Sandercock, Peter A G
A1 Wardlaw, Joanna M
A1 
YR 2021
UL http://svn.bmj.com/content/6/2/238.abstract
AB Background Alteplase 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.Methods We 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.Results Among 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).Conclusion Although 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.The IST-3 data are deposited at https://doi.org/10.7488/ds/1350, available on application to the study investigators.