Effects of Computed Tomography Hyperdense Middle Cerebral Artery Sign on the Efficacy of Endovascular Therapy in Acute Ischemic Stroke With Large Infarcts: A Subgroup Analysis of the ANGEL‐ASPECT Trial
BACKGROUND: The hyperdense middle cerebral artery sign (HMCAS) observed on noncontrast computed tomography is associated with thrombus composition and thrombectomy outcomes. The impact of HMCAS on the efficacy of endovascular therapy (EVT) in patients with large core infarcts remains unclear. METHODS: This analysis uses data from the ANGEL-ASPECT (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core) trial, a multicenter randomized controlled trial conducted in China. Patients with acute ischemic stroke and anterior-circulation large-vessel occlusion were categorized according to whether HMCAS was present on baseline noncontrast computed tomography. The primary outcome was the 90-day modified Rankin Scale score. RESULTS: =0.19). CONCLUSIONS: In this subgroup analysis comparing EVT with medical management, we found no statistically significant treatment-by-HMCAS status interaction, indicating that the benefits of EVT extend to patients with large core infarcts irrespective of HMCAS status. However, the magnitude of benefit appears greater in patients without HMCAS, whereas those with HMCAS tend to have a poorer overall prognosis. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04551664.
Authors
- Weigen Song
- Changming Wen (ORCID: https://orcid.org/0009-0001-0808-9324)
- Ximing Nie (ORCID: https://orcid.org/0000-0002-8380-4076)
- Zaiyu Guo (ORCID: https://orcid.org/0000-0001-5792-2274)
- Jinggang Xuan
- Liqiang Gui
- Guangxian Nan (ORCID: https://orcid.org/0000-0001-7427-6892)
- Alvin Yi-Chou Wang (ORCID: https://orcid.org/0000-0003-4831-3607)
- Jinglun Li (ORCID: https://orcid.org/0000-0002-1588-7076)
- Xiaohui Chen (ORCID: https://orcid.org/0009-0005-6047-9679)
- Linzhi Dai
- Dongsheng Ju
- Geng Liao (ORCID: https://orcid.org/0000-0003-0690-4871)
- Congguo Yin (ORCID: https://orcid.org/0000-0002-8026-4174)
- Mengdi Wang (ORCID: https://orcid.org/0000-0002-2101-9507)
- Chuwei Cai (ORCID: https://orcid.org/0000-0002-7157-2124)
- Shuning Cai
- Tianxiao Li (ORCID: https://orcid.org/0000-0002-2413-6696)
- Wentong Ling
- Cunfeng Song
- Wenhuo Chen
- Junfeng Zhao
- Hongbo Zheng
- Chenhui Liu
- Zan Wang
- Jun Luo
- Xueli Cai
- Hongxing Han
- Yajie Liu
- Tong Li
- Yuesong Pan
- Xiaokun Geng
- Zong’en Gao
- Shudong Liu
- Feng Zhou
- Xiaochuan Huo
- Guangxiong Yuan
- Zhiming Zhou
- Di Li
- Yan Liu
- Na Xu
- Qing Shi
- Yilong Wang
- En Wang
- Changchun Jiang
- Yaxuan Sun
- Jiangang Zhang
- Guoqing Wang
- Yufeng Tang
- Ming Wei
- Xiaoxi Yao
- Zhongrong Miao
- Hua Yang
- Liyong Zhang
- Liping Liu
Institutions
- Capital Medical University (CN)
- Beijing Tian Tan Hospital (CN)
- National Clinical Research Center for Digestive Diseases (CN)
- Chinese Institute for Brain Research (CN)
- Beijing Anzhen Hospital (CN)
- First Affiliated Hospital of Zhengzhou University (CN)
Publication Details
- Journal
- Journal of the American Heart Association
- Published
- 2026-03-31
- DOI
- https://doi.org/10.1161/jaha.125.042473
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 0.00