Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China,
Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China.
Cerebrovasc Dis. 2024;53(5):625-634. doi: 10.1159/000534279. Epub 2023 Oct 12.
The truncal-type occlusion (TTO) sign observed during endovascular thrombectomy is thought to predict the etiology and prognosis of acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, the interpretation of the present results and the clinical utility of this sign need further investigation. This scoping meta-review aimed to assess the predictive value of the TTO sign, thus identifying methodological limitations in current study designs.
Studies published up to January 2023 were identified by systematically searching PubMed, Embase, and Web of Science. A meta-analysis was performed to quantitatively synthesize the evidence on the predictive value of the TTO sign. An 8-point scale was introduced to narratively summarize the current evidence level and methodological quality of included studies.
We included 10 studies in this review. For the prediction of intracranial atherosclerotic stenosis, the sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the TTO sign were 0.73, 0.87, 5.5, and 0.31, respectively (all p < 0.05). For recanalization failure after primary thrombectomy, the sensitivity, specificity, PLR, and NLR were 0.44, 0.91, 4.9, and 0.61, respectively (all p < 0.05). The strength of evidence was low due to the methodological limitations and lack of adjustment for potential confounders.
The predictive values of the TTO sign for the etiology of LVO-AIS were considerable but seemed limited for current interpretation. Several confounders could influence the determination and predictive value of the TTO sign, requiring methodological adjustments in future research. Endovascular practitioners encountering this sign during thrombectomy should draw specific attention to stroke etiology, thus promoting timely adjustment of intra- and postprocedural strategies.
血管内血栓切除术过程中观察到的躯干型闭塞（TTO）征象被认为可以预测因大血管闭塞（LVO）导致的急性缺血性脑卒中（AIS）的病因和预后。然而，目前对于这一征象的解读以及其临床应用价值需要进一步研究。本范围综述旨在评估 TTO 征象的预测价值，从而确定当前研究设计中的方法学局限性。
通过系统检索 PubMed、Embase 和 Web of Science，确定截至 2023 年 1 月发表的研究。进行荟萃分析以定量综合 TTO 征象预测价值的证据。采用 8 分制对纳入研究的当前证据水平和方法学质量进行叙述性总结。
本综述纳入 10 项研究。对于颅内动脉粥样硬化性狭窄的预测，TTO 征象的敏感性、特异性、阳性似然比（PLR）和阴性似然比（NLR）分别为 0.73、0.87、5.5 和 0.31（均 p < 0.05）。对于初次血栓切除术后再通失败，TTO 征象的敏感性、特异性、PLR 和 NLR 分别为 0.44、0.91、4.9 和 0.61（均 p < 0.05）。由于方法学局限性和缺乏对潜在混杂因素的调整，证据力度较低。
TTO 征象对 LVO-AIS 病因的预测价值相当，但目前的解读似乎有限。一些混杂因素可能影响 TTO 征象的确定和预测价值，这需要在未来的研究中进行方法学调整。血管内介入医师在血栓切除术中遇到这一征象时，应特别注意脑卒中的病因，从而及时调整术中和术后的策略。
