%0 Journal Article %A C.O.A. Tsang %A I.H.W. Cheung %A K.K. Lau %A W. Brinjikji %A D.F. Kallmes %A T. Krings %T Outcomes of Stent Retriever versus Aspiration-First Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis %D 2018 %R 10.3174/ajnr.A5825 %J American Journal of Neuroradiology %X 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.ADAPTA Direct Aspiration, First Pass Technique for the Endovascular Treatment of StrokePRISMAPreferred Reporting Items for Systematic Reviews and Meta-AnalysesRCTrandomized controlled trialSRTstent-retriever thrombectomy %U https://www.ajnr.org/content/ajnr/early/2018/10/18/ajnr.A5825.full.pdf