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Original research
Angiographic tapering sign as a surrogate marker for large vessel occlusion due to intracranial atherosclerotic stenosis and its clinical implication: a retrospective matched case–control study
  1. Kwang-Chun Cho1,
  2. Nak-Hoon Son2,
  3. Jin Wook Choi3,
  4. Woo Sang Jung3
  1. 1 Neurosurgery, Yongin Severance Hospital, Yongin, Korea
  2. 2 Statistics, Keimyung University, Daegu, Korea
  3. 3 Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Korea
  1. Correspondence to Professor Woo Sang Jung, Radiology, Ajou University Hospital, Suwon, Korea (the Republic of); stepws{at}


Background The purpose of this study was to investigate whether the initial DSA appearance of the occlusion during mechanical thrombectomy (MT) can help distinguish the nature of the underlying lesion and predict radiological and clinical outcomes.

Methods We retrospectively reviewed cases of patients with acute ischemic stroke who underwent MT for anterior circulation occlusion between March 2017 and February 2020. Underlying intracranial atherosclerotic stenosis (ICAS) was determined based on the presence of fixed stenosis after endovascular treatment. Patients were categorized based on the appearance of the occlusion observed in the initial DSA as tapering sign (+) or (−) groups. We performed 1:2 propensity score matching to establish a proper control group among the tapering sign (−) group. We analyzed and compared baseline characteristics and clinical outcomes between the two groups.

Results A total of 293 patients (tapering sign (+), n=47; tapering sign (−), n=246) were included in the analysis. The procedure time of MT was significantly longer for the tapering sign (+) group, and the successful recanalization rate after MT was significantly lower in the tapering sign (+) group than in the tapering sign (−) group. Logistic regression showed that ICAS-related occlusion was strongly associated with a positive angiographic tapering sign, and the angiographic tapering sign was a negative factor for the first-pass effect during MT. However, a 3-month good functional outcome was not significantly associated with the angiographic tapering sign.

Conclusions The tapering sign on the initial DSA could be a surrogate marker for ICAS-related occlusion and procedural difficulty. However, its clinical significance remains unclear.

  • atherosclerosis
  • stroke
  • thrombectomy
  • angiography

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors K-CC contributed to this work as first author. WSJ contributed to this work as the corresponding author and responsible for the overall content as guarantor. K-CC, JWC, and WSJ gathered the data and collaboratively drafted the manuscript. N-HS contributed to the statistical analysis of the data. All authors approved the final version of the manuscript.

  • Funding This work was supported by a research grant provided by Ajou University Hospital, 2020.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.