爪征：大脑大血管闭塞机械取栓术后再通的血管造影预测指标
The Claw Sign: An angiographic Predictor of Recanalization After Mechanical Thrombectomy for Cerebral Large Vessel Occlusion.
作者信息
Yamamoto Yuki, Yamamoto Nobuaki, Kanematsu Yasuhisa, Korai Masaaki, Shimada Kenji, Izumi Yuishin, Takagi Yasushi
机构信息
Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
出版信息
J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1555-1560. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.007. Epub 2019 Mar 28.
BACKGROUND
Mechanical thrombectomy undoubtedly improves functional outcomes for patients with acute ischemic stroke. Although we have observed occlusion sites that protrude proximally into the vessel on angiography, termed the "claw sign," we have been unable to state its clinical significance. In this study, we aimed to determine whether the presence of a claw sign was related to recanalization success after mechanical thrombectomy.
MATERIALS AND METHODS
We retrospectively included 73 consecutive patients treated for acute cerebral large vessel occlusion by mechanical thrombectomy between January 2014 and December 2017. The angiographic claw sign was defined as a thrombus that protruded proximally by more than half the diameter of the parent artery. Claw sign positivity, clinical and etiological features, and outcomes were compared between groups with and without recanalization.
RESULTS
The claw sign was observed in 29 of 73 (40%) patients and was positive significantly more frequently in those with recanalization (50.0%) than in those without recanalization (5.9%) (P < .01). By multivariate analysis, the claw sign was the only pretreatment parameter to predict successful recanalization (odds ratio, 12.50; 95% confidence interval, 1.50-103.00; P = .019).
CONCLUSIONS
The presence of the claw sign might predict successful recanalization in patients undergoing mechanical thrombectomy for large vessel occlusion.
背景
机械取栓无疑可改善急性缺血性卒中患者的功能预后。尽管我们在血管造影中观察到血栓近端突出至血管内的闭塞部位，即“爪征”，但我们尚无法阐明其临床意义。在本研究中，我们旨在确定爪征的存在是否与机械取栓后的再通成功相关。
材料与方法
我们回顾性纳入了2014年1月至2017年12月期间接受机械取栓治疗急性大脑大血管闭塞的73例连续患者。血管造影爪征定义为血栓向近端突出超过母动脉直径的一半。比较有再通和无再通两组患者的爪征阳性情况、临床和病因学特征以及预后。
结果
73例患者中有29例（40%）观察到爪征，有再通的患者中爪征阳性的频率（50.0%）显著高于无再通的患者（5.9%）（P <.01）。多因素分析显示，爪征是预测再通成功的唯一预处理参数（比值比，12.50；95%置信区间，1.50 - 103.00；P =.019）。
结论
爪征的存在可能预测接受大脑大血管闭塞机械取栓患者的再通成功。
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