• Yuki Yamamoto, Nobuaki Yamamoto, Yasuhisa Kanematsu, Masaaki Korai, Kenji Shimada, Yuishin Izumi, and Yasushi Takagi.
• Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan. Electronic address: yuki.yamamoto412@gmail.com.
• J Stroke Cerebrovasc Dis. 2019 Jun 1; 28 (6): 1555-1560.

BackgroundMechanical thrombectomy undoubtedly improves functional outcomes for patients with acute ischemic stroke. Although we have observed occlusion sites that protrude proximally into the vessel on angiography, termed the "claw sign," we have been unable to state its clinical significance. In this study, we aimed to determine whether the presence of a claw sign was related to recanalization success after mechanical thrombectomy.Materials And MethodsWe retrospectively included 73 consecutive patients treated for acute cerebral large vessel occlusion by mechanical thrombectomy between January 2014 and December 2017. The angiographic claw sign was defined as a thrombus that protruded proximally by more than half the diameter of the parent artery. Claw sign positivity, clinical and etiological features, and outcomes were compared between groups with and without recanalization.ResultsThe claw sign was observed in 29 of 73 (40%) patients and was positive significantly more frequently in those with recanalization (50.0%) than in those without recanalization (5.9%) (P < .01). By multivariate analysis, the claw sign was the only pretreatment parameter to predict successful recanalization (odds ratio, 12.50; 95% confidence interval, 1.50-103.00; P = .019).ConclusionsThe presence of the claw sign might predict successful recanalization in patients undergoing mechanical thrombectomy for large vessel occlusion.Copyright © 2019 Elsevier Inc. All rights reserved.

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