Table 3.
Baseline characteristics and main outcomes of included studies (quantitative synthesis).
| References | No. of patients | Treatment modalities and devices (n, %) | Method of ROI drawing | Age | Male n, %) | NIHSS | IVT administered (n, %) | Stroke etiology (n, %) | Thrombus location (n, %) | Thickness (mm) | Successful reperfusion mean ± SD HU (n) | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Yes | No | P-value | |||||||||||
| Yilmaz et al. (18) | 70 | SR (Solitaire FR, pREset, Trevo, Aperio) |
Manually drawn within thrombus | 72 ± 12 | 37 (52.9%) | NA | 36 (51.4%) | NA | M1 | 5 | 50.1 ± 7.8 (57) | 48.7 ± 8.2 (13) | 0.567 |
| Spiotta et al. (19) | 95 | Routinely penumbra; first-generation SR available |
Manually drawn small circles | NA | NA | NA | 32 (33.7%) | NA | NA | 4.8 | 57.1 ± 16.3 (72) | 68.7 ± 43.2 (23) | 0.22 |
| Mokin et al. (20) | 41 | SR (Solitaire) | Manually outlined the margin | 67.9 ± 12.869.1 ± 12.5 | 12 (50%) 5 (29.4%) |
17.0 ± 4.216.4 ± 4.3 | 8 (33.3%) 5 (29.4%) |
NA | ICA terminus; M1; M2 |
5 | 49.9 ± 7.6 (24) | 43.8 ± 6.6 (17) | 0.01 |
| Shu et al. (21) |
51 | Aspiration (13, 25.5%); SR (27, 52.9%); Aspiration and SR (2, 3.9%); Other (9, 17.6%) |
Manually outlined the margin | 72 (66–68) | 36 (70.6%) | 18 (14–23) | 8 (15.7%) | LAA (30, 58.8%); CE (13, 25.5%); Other (5, 9.8%); Unknown (3, 5.9%) |
Proximal BA (10, 19.6%); Mid BA (21, 41.2%); Tip BA (20, 39.2%) |
2.5 | 52.3 ± 5.8 (41) | 48.4 ± 6.7 (10) | 0.07 |
| Jagani et al. (22) | 118 | Aspiration (30, 25%); SR (30, 25%); Aspiration and SR (25, 21%); Other (33, 28%) |
Manually drawn within thrombus | 66 ± 13 | 62 (53%) | NA | NA | LAA (35, 30%); CE (56, 47%); Other (6, 5%); Unknown (21, 18%) |
MCA/M1 (65, 55.1%); Intracranial ICA (5, 4.2%); T Occlusion (13, 11.0%); L Occlusion (16, 13.5%); BA (19, 16.1%) |
5 | 50.1 ± 7.4 (80) | 53.0 ± 12.7 (38) | 0.17 |
| Ye et al., 2019 (the present study) | 64 | Aspiration (26, 40.6%); SR (21, 32.8%); Aspiration and SR (17, 26.6%); |
Manually drawn within thrombus | 74.5 (63.25-82) | 34 (53.1%) | 14.5 (11–19) | 19 (29.7%) | LAA (16, 25.0%); CE (37, 57.8%); Other (2, 3.1%); Unknown (9, 14.1%) |
ICA (18, 28.1%); M1 (25, 39.1%); Tandem 7 (10.9%) Distal 14 (21.9%) |
1 | 65.27 ± 9.42 (57) | 62.19 ± 17.01 (7) | 0.462 |
| References | No. of patients | Treatment strategies | Thickness (mm) | Method of ROI drawing | Age | Male (n, %) | NIHSS | IVT administered (n, %) | Stroke etiology (n, %) | Thrombus location (n, %) | Statistical method | Conclusion | |
| Original article | Froehler et al. (23) | 67 | Merci | 4.8 | Manually drawn small circles or drawn within thrombus | 69.3 | 26 (38.8%) |
19 | 23 (34.3%) | NA | ICA; M1 | Chi-square or Fisher's exact test | Successful recanalization was achieved in 79% (33/42) of patients exhibiting the HVS compared with only 36% (9/25) of patients without the HVS. |
| Moftakhar et al. (24) | 90 | MT (Merci or Penumbra) | 2.5 | Manually drawn within thrombus | 69 | 43 (47.8%) |
NA | NA | NA | NA | Student t tests | Patients with TICI ≥ 2 demonstrated higher HU on NECT (mean corrected HU mechanical treatment = 1.7) compared with patients with TICI <2 (mechanical treatment = 1.3) (P = <0.0001). | |
| Kim et al. (25) | 212 | SR Aspiration and SR Other |
4.8 | NA | 72 (65–79) | 107 (50.5%) |
13 (10–16) |
143 (67.5%) | LAA (126, 59.4%); CE (45, 21.2%); Unknown (41, 19.3%) |
M1; M2 |
Chi-square or Fisher's exact test | There were no significant differences between patients with an HMCAS and those with a negative HMCAS in the rates of successful reperfusion (83.1 vs. 81.9%, P = 0.829). | |
| Conference abstract | Cardona et al. (26) | 183 | SR | NA | NA | 64.5 ± 12 |
99 (54%) |
17 (6–26) |
97 (53.0%) | NA | M1 (142, 77.6%); M2 (25, 13.7%); T-ICA (16, 8.7%) |
ROC analysis | In receiver operating characteristic (ROC) analysis attenuations of the clots was associated with a higher rate of recanalization TICI 2b-3 (AUC = 0.782;numbers of tumor-infiltrating p = 0.001). |
| Kenmuir et al. (27) | 408 | Manual aspiration; or SR mediated manual aspiration |
NA | NA | 67.7 | 216 (53%) |
17 | NA | NA | MCA; BA | Chi-square or Fisher's exact test | TICI 2b/3 reperfusion on first-pass was associated with the absence of HDVS (p = 0.001). | |
Data were represented as mean ± SD or median (IQR).
Mokin et al. (20) reported age, the proportion of sex, and NIHSS according to successful reperfusion or not (upper-successful reperfusion; below-unsuccessful reperfusion).
ROI, region of interest; NIHSS, National Institutes of Health Stroke Scale; IVT, intravenous thrombolysis; HU, Hounsfield unit; LAA, large artery atherosclerosis; CE, cardiogenic embolism; ICA, internal carotid artery; MCA, middle cerebral artery; BA, basilar artery; PCA, posterior cerebral artery; SR, stent retriever; ROC, receiver operating characteristic; HVS/HDVS, hyperdense vessel sign; MT, mechanical thrombectomy; TICI, thrombolysis in cerebral ischemia; HMCAS, hyperdense middle cerebral artery sign; NA, not available.