Highlights
- •The presence of SVS appears to be a stronger predictor of cardioembolic stroke.
- •SVS was associated with low recanalization and poor outcome in AIS patients after IVT but not after EVT.
- •The recanalization rate increased with the decreasing SVS length but not with the decreasing width.
- •Our data offered a practical information to select optimal therapeutic strategies for stroke patients with SVS.
Abstract
Acute ischemic stroke (AIS) subtype, one of the most important factors for selecting
therapeutic strategies, is difficult to be accurately diagnosed at admission sometimes.
The magnetic susceptibility effect of deoxygenated hemoglobin in red thrombi appeared
as hypointense signals in magnetic resonance imaging (MRI) scans. The prognostic value
of susceptibility vessel sign (SVS) for stroke subtype, recanalization and outcomes
in AIS patients will be comprehensively determined in the present study. A comprehensive
search of databases was conducted including the PubMed, Embase, and Cochrane Library
from inception up to August 2017. Statistical tests were performed to check for heterogeneity
and publication bias. Subgroup and sensitivity analysis were also conducted to evaluate
the robustness of the conclusions. Overall, 21 studies including 1832 patients were
identified. The presence of SVS was significantly associated with cardioembolic stroke
than absence of SVS (RR = 1.53, 95% CI = 1.30–1.81, p < 0.001). The patients with
SVS were less likely to achieve recanalization (RR = 0.70, 95% CI = 0.56–0.88, p = 0.002)
and poor functional outcome (RR = 1.68, 95% CI = 1.44–1.97, p < 0.001) after intravenous
thrombolysis (IVT), whereas it was similar between two group after endovascular treatment
(EVT) (p = 0.990 and p = 0.335). The SVS length was smaller in recanalization group
than that in non-recanalization group (RR = −0.49, 95% CI = −0.72 to −0.27, p < 0.001),
however, no significant difference between SVS width and recanalization rate was found.
The presence of SVS appears to be a stronger predictor of cardioembolic stroke. Furthermore,
the SVS was associated with a decreasing recanalization rate and poor outcome in AIS
patients after IVT but not after EVT. Which offered a practical information to select
optimal therapeutic strategies for stroke patients with SVS though the level of evidence
seems to be quite shaky.
Keywords
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Article info
Publication history
Published online: January 31, 2019
Accepted:
January 3,
2019
Received:
February 20,
2018
Identification
Copyright
© 2019 Published by Elsevier Ltd.
