Clot Meniscus Sign Is Associated With Thrombus Permeability and Choice of Mechanical Thrombectomy Technique in Acute Middle Cerebral Artery Occlusion.

Chuang Nie,Bin Mei,Xiangbo Wu,Mengqi Tu,Dong Sun,Zhiming Kang

doi:10.3389/fneur.2022.850429

Chuang Nie, Bin Mei + Show 4 more

Open Access

https://doi.org/10.3389/fneur.2022.850429

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Abstract

Background and PurposeThe method of mechanical thrombectomy (MT) is related to vascular anatomy and stroke etiology. Meniscus sign and thrombus permeability as imaging markers may be instructive for the selection of MT. This study aims to clarify the relationship among meniscus sign, thrombus permeability, and choice of MT in patients with acute middle cerebral artery occlusion.Materials and MethodsA total of 111 patients with acute middle cerebral artery occlusion (MCAO) who underwent MT were retrospectively analyzed. Clot meniscus sign was defined as the appearance of meniscoid/edge-like or single- or double-wall contrast channels besides or around insular blood clots. The radiographic, clinical, and surgical data of patients with MCAO with or without meniscus sign were compared.ResultsThe meniscus sign positive group (n = 26) has higher thrombus permeability (HUs) (26.92 ± 9.69 vs. 22.84 ± 7.88, p = 0.031) than those without it. Shorter puncture-to-recanalization (P2R) time (65.5 vs. 88, p = 0.012), higher complete recanalization rate (85.71 vs. 33.33%, p < 0.01), and better clinical outcome (p < 0.01) were obtained by selecting contact aspiration (CA) over stent retriever (SR) in patients with positive meniscus sign. In patients with negative meniscus sign, there was no significant difference in clinical outcome after receiving CA or SR.ConclusionPatients with MCAO with positive meniscus sign have higher thrombus permeability and are more suitable for CA to acquire better clinical outcomes.

Highlights

Since 2015, a series of clinical trials has been demonstrating great advantages of mechanical thrombectomy (MT) in treatment of patients with acute large vessel occlusion [1]
This study aims to clarify the relationship among meniscus sign, thrombus permeability, and choice of MT in patients with acute middle cerebral artery occlusion
In patients with negative meniscus sign, there was no significant difference in clinical outcome after receiving contact aspiration (CA) or SignStent retriever (SR)

Summary

Introduction

Since 2015, a series of clinical trials has been demonstrating great advantages of mechanical thrombectomy (MT) in treatment of patients with acute large vessel occlusion [1]. Differences in vascular anatomy of anterior and posterior circulation and classification of stroke etiology may lead to different results when choosing SR or CA. As an index of pre-procedural imaging, is considered to be associated with etiological classification of stroke and the rate of first-pass recanalization in patients who underwent CA [5, 6]. Compared with the regular occlusion subtype, the meniscus sign usually indicates higher recanalization rate, fewer operations, and better clinical outcomes [7, 9]. The method of mechanical thrombectomy (MT) is related to vascular anatomy and stroke etiology. This study aims to clarify the relationship among meniscus sign, thrombus permeability, and choice of MT in patients with acute middle cerebral artery occlusion

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