Abstract
BACKGROUND: There is ongoing debate regarding the optimal first-line thrombectomy technique for large-vessel occlusion.
PURPOSE: We performed a systematic review and meta-analysis of comparative studies on stent retriever–first and aspiration-first thrombectomy.
DATA SOURCES: We searched Ovid MEDLINE, PubMed, and EMBASE from 2009 to February 2018.
STUDY SELECTION: Two reviewers independently selected the studies. The primary end point was successful reperfusion (TICI 2b/3).
DATA ANALYSIS: Random-effects meta-analysis was used for analysis.
DATA SYNTHESIS: Eighteen studies including 2893 patients were included. There was no significant difference in the rate of final successful reperfusion (83.9% versus 83.3%; OR = 0.87; 95% CI, 0.62%–1.27%) or good functional outcome (mRS 0–2) at 90 days (OR = 1.07; 95% CI, 0.80–1.44) between the stent-retriever thrombectomy and aspiration groups. The stent-retriever thrombectomy–first group achieved a statistically significant higher TICI 2b/3 rate after the first-line device than the aspiration-first group (74.9% versus 66.4%; OR = 1.53; 95% CI, 1.14%–2.05%) and resulted in lower use of a rescue device (19.9% versus 32.5%; OR = 0.36; 95% CI, 0.14%–0.90%). The aspiration-first approach resulted in a statistically shorter groin-to-reperfusion time (weighted mean difference, 7.15 minutes; 95% CI, 1.63–12.67 minutes). There was no difference in the number of passes, symptomatic intracerebral hemorrhage, vessel dissection or perforation, and mortality between groups.
LIMITATIONS: Most of the included studies were nonrandomized. There was significant heterogeneity in some of the outcome variables.
CONCLUSIONS: Stent-retriever thrombectomy–first and aspiration-first thrombectomy were associated with comparable final reperfusion rates and functional outcome. Stent-retriever thrombectomy was superior in achieving reperfusion as a stand-alone first-line technique, with lower use of rescue devices but a longer groin-to-reperfusion time.
ABBREVIATIONS:
- ADAPT
- A Direct Aspiration, First Pass Technique for the Endovascular Treatment of Stroke
- PRISMA
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RCT
- randomized controlled trial
- SRT
- stent-retriever thrombectomy
Footnotes
Disclosures: Chun On Anderson Tsang—RELATED: Grant: Health and Medical Research Fund of Hong Kong (01150027), Comments: a peer-reviewed medical research grant provided by the Hong Kong government through the Food and Health Bureau.* David F. Kallmes—UNRELATED: Consultancy: Medtronic, Comments: clinical trials*; Grants/Grants Pending: Medtronic, Neuravi, Comments: preclinical and clinical research*; Patents (Planned, Pending or Issued): Mayo Clinic, Comments: balloon-guided devices; Stock/Stock Options: Marblehead Medical, Comments: stroke access device development. *Money paid to the institution.
This study was supported by the Health and Medical Research Fund of Hong Kong (01150027).
- © 2018 by American Journal of Neuroradiology
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