The different clinical value of susceptibility vessel sign in acute ischemic stroke patients under different interventional therapy: A systematic review and meta-analysis

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.