Azriel Amit, Horev Anat, Avraham Elad, Alguayn Farouq, Zlotnik Yair, Ifergane Gal, Sufaro Yuval Zeev, Dizitzer Yotam, Melamed Israel, Shelef Ilan, Cohen José E, Leker Ronen R, Honig Asaf
Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Department of Neurology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Front Neurol. 2022 Dec 13;13:1041585. doi: 10.3389/fneur.2022.1041585. eCollection 2022.
We aimed to assess the clinical significance of M1-MCA occlusion with visualization of both MCA-M2 segments ["Tilted-V sign" (TVS)] on initial CT angiography (CTA) in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT).
Data for patients with consecutive AIS undergoing EVT for large vessel occlusion (LVO) in two academic centers are recorded in ongoing databases. Patients who underwent EVT for M1-MCA occlusions ≤ 6 h from symptom onset were included in this retrospective analysis.
A total of 346 patients met the inclusion criteria; 189 (55%) had positive TVS. Patients with positive TVS were younger (68 ± 14 vs. 71 ± 14 years, = 0.028), with similar rates of vascular risk factors and baseline modified Rankin scores (mRS) 0-2. The rates of achieving thrombolysis in cerebral ischemia (TICI) 2b-3 were similar to the two groups (79%), although successful first-pass recanalization was more common with TVS (64 vs. 36%, = 0.01). On multivariate analysis, higher collateral score [odds ratio (OR) 1.38 per unit increase, = 0.008] and lower age (OR 0.98 per year increase, = 0.046) were significant predictors of TVS. Patients with positive TVS had higher post-procedural Alberta Stroke Program Early CT Score (ASPECTS; 6.9 ± 2.2 vs. 5.2 ± 2.3, = 0.001), were discharged with lower National Institutes of Health Stroke Score (NIHSS; 6±6 vs. 9±7, = 0.003) and higher rates of mRS 0-2 (29.5 vs. 12%, = 0.001), and had lower rates of 90-day mortality (13.2 vs. 21.6%, = 0.038). However, TVS was not an independent predictor of functional independence (OR 2.51; 95% CI 0.7-8.3).
Tilted-V Sign, an easily identifiable radiological marker, is associated with fewer recanalization attempts, better functional outcomes, and reduced mortality.
我们旨在评估在接受血管内血栓切除术（EVT）的急性缺血性卒中（AIS）患者中，初始CT血管造影（CTA）上M1 - 大脑中动脉（MCA）闭塞且同时显示MCA - M2段["倾斜V征"（TVS）]的临床意义。
两个学术中心正在进行的数据库记录了连续接受EVT治疗大血管闭塞（LVO）的AIS患者的数据。本回顾性分析纳入了症状发作后≤6小时接受M1 - MCA闭塞EVT治疗的患者。
共有346例患者符合纳入标准；189例（55%）有阳性TVS。TVS阳性患者更年轻（68±14岁对71±14岁，P = 0.028），血管危险因素发生率和基线改良Rankin量表评分（mRS）0 - 2相似。两组达到脑缺血溶栓（TICI）2b - 3级的比例相似（79%），尽管TVS组首次通过再通更常见（64%对36%，P = 0.01）。多因素分析显示，较高的侧支循环评分[每增加一个单位比值比（OR）1.38，P = 0.008]和较低的年龄（每年增加OR 0.98，P = 0.
