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Can the clot meniscus and claw signs predict thrombectomy and clinical outcomes in patients with stroke? A systematic review and meta-analysis
  1. Abdullah Reda1,2,
  2. Jonathan Cortese2,3,
  3. Sherief Ghozy1,2,
  4. Aryan Gajjar2,
  5. Dani Douri1,
  6. Ramanathan Kadirvel1,
  7. David F Kallmes2
    1. 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
    2. 2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
    3. 3NEURI- Neurointerventional Radiology, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
    1. Correspondence to Dr Abdullah Reda; mohammed.abdullah{at}mayo.edu

    Abstract

    Background The angiographic shape of an occlusion, like the clot meniscus sign and the claw sign, has been reported to potentially impact the recanalization rate and clinical outcome in patients undergoing mechanical thrombectomy for acute ischemic strokes.

    Method Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, Embase and Web of Science databases. Patients were grouped into clot meniscus/claw sign positive and negative groups based on the definitions obtained from each study. Primary outcomes included technical success, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95% confidence intervals (Cl).

    Results We included seven studies recruiting 1572 patients. The results indicated that the positive and negative groups had comparable first-pass effect (OR 1.95; 95% CI 0.76 to 5.01; P=0.167) and final recanalization (OR 1.36; 95% CI 0.81 to 2.27; P=0.248) rates. However, the rate of having a favorable functional outcome was significantly higher in the positive group than in the negative sign group (OR 1.91; 95% CI 1.25 to 2.92; P<0.003). Within the sign-positive population, the use of contact aspiration was associated with a significantly higher rate of recanalization compared with using a stent retriever (OR 0.18; 95% CI 0.07 to 0.49; P<0.001). This result did not translate into a clinical impact, as both stent retriever and contact aspiration showed comparable rates of functional independence at 3 months (OR 0.22; 95% CI 0.02 to 2.33; P=0.210).

    Conclusion The presence of the clot meniscus/claw sign is not associated with recanalization outcomes after thrombectomy. However, it might be a good sign to predict which thrombectomy technique might be associated with better recanalization, although current evidence may need further confirmation.

    • Stroke
    • Thrombectomy
    • Angiography
    • Thrombolysis
    • Stent

    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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    Footnotes

    • Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: AR, JC, SG, DD, AG. Drafting the work or revising it critically for important intellectual content: AR, JC, SG, RK. Final approval of the version to be published: DFK. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: AR, JC, SG, DD, AG, RK, DFK. AR is the guarantor of the overall study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JC received an educational grant from Medtronic, Phenox, Microvention, the French Society of Radiology and the French Society of Neuroradiology and received honoraria for lectures from Balt, all unrelated to this work. DFK received research support from Cerenovus, Sensome, Neurogami Medical, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, MiVi, Stryker and NIH; royalties from Medtronic; is on the DSMB of NoNO Inc and Vesalio; is a stockholder of Nested Knowledge, Superior Medical Experts, Marblehead Medical, and Conway Medical, all unrelated to this work.

    • 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.