• Grant Mair, Elena V Boyd, Francesca M Chappell, Rüdiger von Kummer, Richard I Lindley, Peter Sandercock, Joanna M Wardlaw, and IST-3 Collaborative Group.
• From 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.).
• Stroke. 2015 Jan 1; 46 (1): 102-7.

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 Urlhttp://www.controlled-trials.com/ISRCTN25765518. Unique identifier: ISRCTN25765518.© 2014 American Heart Association, Inc.

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