The Role Of Truncal-type Occlusion Sign In Mechanical Thrombectomy For Acute Large Artery Occlusion Stroke:a Meta-analysis

Background and Objective:The clinical prognosis of patients with large vessel occlusion related-acute ischemic stroke（LVO-AIS）has been largely improved by mechanical thrombectomy.We performed a meta-analysis to gain a better understanding into the role of truncal-type occlusion（TTO）sign in mechanical thrombectomy of LVO-AIS.Methods:Studies published up to August 2021 were identified by systematically searching Pubmed,Web of sicence and Embase databases,which investigated the prediction of TTO for the etiology or endovascular outcomes of LVO-AIS.Principal measurements of the meta-analysis were the overall sensitivity,specificity,the positive likelihood ratio（PLR）,and the negative likelihood ratio（NLR）of TTO in predicting intracranial atherosclerotic stenosis related-LVO（ICAS-LVO）and recanalization failure（RF）after initial thrombectomy.Results:We included 7 studies（n =1583）.For ICAS-LVO,TTO had a sensitivity of 0.73（95% CI 0.36–0.93）,a specificity of 0.88（95% CI 0.82–0.92）,the area under the receiver operating characteristic curve（AUC）was 0.90（95% CI 0.87–0.92）,PLR was6.1（95% CI 3.9–9.6）,and NLR was 0.31（95% CI 0.10–0.94）.For RF after initial thrombectomy,TTO had a sensitivity of 0.44（95% CI 0.33–0.57）,a specificity of0.91（95% CI 0.82–0.96）,AUC was 0.69（95% CI 0.65–0.73）,PLR was 4.9（95% CI2.8–7.6）,and NLR was 0.61（95% CI 0.51–0.73）.Conclusion:1.Patients with the TTO sign tended to have an ICAS etiology that could potentially be refractory to recanalization and required tailored EVT protocols.2.As a presumed predictor of angiographic outcome and stroke etiology,many factors may have influenced the results of the current studies of TTO that are worthy of further investigation.