Clot Meniscus Sign Is Associated With Thrombus Permeability and Choice of Mechanical Thrombectomy Technique in Acute Middle Cerebral Artery Occlusion

Abstract

Background and PurposeThe method of mechanical thrombectomy (MT) is related to vascular anatomy and stroke etiology. Meniscus sign and thrombus permeability as imaging markers may be instructive for the selection of MT. This study aims to clarify the relationship among meniscus sign, thrombus permeability, and choice of MT in patients with acute middle cerebral artery occlusion.Materials and MethodsA total of 111 patients with acute middle cerebral artery occlusion (MCAO) who underwent MT were retrospectively analyzed. Clot meniscus sign was defined as the appearance of meniscoid/edge-like or single- or double-wall contrast channels besides or around insular blood clots. The radiographic, clinical, and surgical data of patients with MCAO with or without meniscus sign were compared.ResultsThe meniscus sign positive group (n = 26) has higher thrombus permeability (HUs) (26.92 ± 9.69 vs. 22.84 ± 7.88, p = 0.031) than those without it. Shorter puncture-to-recanalization (P2R) time (65.5 vs. 88, p = 0.012), higher complete recanalization rate (85.71 vs. 33.33%, p < 0.01), and better clinical outcome (p < 0.01) were obtained by selecting contact aspiration (CA) over stent retriever (SR) in patients with positive meniscus sign. In patients with negative meniscus sign, there was no significant difference in clinical outcome after receiving CA or SR.ConclusionPatients with MCAO with positive meniscus sign have higher thrombus permeability and are more suitable for CA to acquire better clinical outcomes.

Meniscus Sign in Patients with Anterior Circulation Large Vessel Occlusion Stroke does not Predict Outcome

“…A possible link supporting this hypothesis is that thrombi with cardioembolic origin, usually rich in fibrin and platelets, also have an increased perviousness in computed tomography [21], which is known to be associated with higher success of intravenous thrombolysis [22]. Although, in our study, the meniscus sign was more frequent in patients with cardioembolic stroke etiology, studies report conflicting results in what the association between meniscus sign and thrombus perviousness is concerned [8,23].…”

“…Successful reperfusion was, however, not different between the two different primary techniques and clinical outcomes were similar. A recent study of patients with M1 and M2 occlusions showed better complete recanalization rates and better functional outcomes in patients with meniscus sign who had been treated with contact aspiration in comparison to stent-retriever [23]. Although contact aspiration technique in patients with meniscus sign was independently associated with complete recanalization, the analysis for the prediction of outcome was not adjusted for relevant co-variates in this study.…”

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“…It has been postulated that clots with a meniscus sign may be rich in red blood cells and break down easily compared to a fibrin clot. Supporting this are studies which identified a higher recanalization rate and better functional outcomes in patients who received direct aspiration as opposed to stent retriever for LVO AIS presenting with a meniscus sign (10). However, a more recent multicentric study involving prospective local registries of high-volume centres subsequently demonstrated little prognostic significance for the meniscus sign, consistent with what was found in our center (26).…”

“…For example, poor baseline collateral flow status and Alberta Stroke Program Early CT Score (ASPECTS), assessed via CT angiography, are associated with a larger ischemic core and worse functional outcomes (5,6). Other radiological variables which have been investigated include clot characteristics including clot length, density, surface phenotype, truncal versus branch-type occlusions and the presence of a meniscus sign (7)(8)(9)(10)(11). Further radiological variables that have been studied pertain to vascular anatomy and include parameters that quantify vascular tortuosity such as the aortic arch type (12,13).…”

Pre-treatment radiological factors associated with poor functional outcome in an Asian cohort of large vessel occlusion acute ischemic stroke patients undergoing mechanical thrombectomy

“…For example, poor baseline collateral flow status and Alberta Stroke Program Early CT Score (ASPECTS), assessed via CT angiography, are associated with a larger ischemic core and worse functional outcomes (5,6). Other radiological variables which have been investigated include clot characteristics including clot length, density, surface phenotype, truncal versus branch-type occlusions and the presence of a meniscus sign (7)(8)(9)(10)(11). Further radiological variables that have been studied pertain to vascular anatomy and include parameters that quantify vascular tortuosity such as the aortic arch type (12,13).…”