Distal medium vessel occlusions in acute ischaemic stroke – Stent retriever versus direct aspiration: A systematic review and meta-analysis

Autor: Keith Zhi Xian Toh, Ming Yi Koh, Enver De Wei Loh, Gabriel Yi Ren Kwok, Yao Hao Teo, Yao Neng Teo, Claire Xin Yi Goh, Nicholas Li Xun Syn, Andrew Fu Wah Ho, Ching-Hui Sia, Patrick A Brouwer, Tommy Andersson, Lukas Meyer, Jens Fiehler, Pervinder Bhogal, Vijay K Sharma, Benjamin YQ Tan, Leonard L L Yeo
Rok vydání: 2023
Předmět:
Zdroj: European Stroke Journal. 8:434-447
ISSN: 2396-9881
2396-9873
DOI: 10.1177/23969873231151262
Popis: Background Acute ischaemic stroke due to distal medium vessel occlusion (AIS-DMVO) causes significant morbidity. Endovascular thrombectomy advancement has made treating AIS-DMVO with stent retrievers (SR) and aspiration catheters (AC) possible, however the optimal technique remains unknown. We performed a systematic review and meta-analysis to investigate the efficacy and safety of SR use compared to purely AC use in patients with AIS-DMVO. Methods We systematically searched PubMed, Cochrane Library and EMBASE, from inception to 2nd September 2022, for studies comparing SR or primary combined (SR/PC) against AC in AIS-DMVO. We adopted the Distal Thrombectomy Summit Group’s definition of DMVO. Efficacy outcomes were functional independence (modified Rankin Scale (mRS) 0–2 at 90 days), first pass effect (modified Thrombolysis in Cerebral Infarction scale (mTICI) 2c-3 or expanded Thrombolysis in Cerebral Infarction scale (eTICI) 2c-3 at first pass), successful final recanalisation (mTICI or eTICI 2b-3), and excellent final recanalisation (mTICI or eTICI 2c-3). Safety outcomes were symptomatic intracranial haemorrhage (sICH) and 90-day mortality. Results 12 cohort studies and 1 randomised-controlled trial were included, involving 1881 patients with 1274 receiving SR/PC and 607 receiving AC only. SR/PC achieved higher odds of functional independence (odds ratio (OR) 1.33, 95% confidence interval (CI) 1.06–1.67) and lower odds of mortality (OR 0.69, 95% CI 0.50–0.94) than AC. Odds of successful/excellent recanalisation and sICH were similar between both groups. Stratified to compare only SR and only AC, the use of only SR, achieved significantly higher odds of successful recanalisation as compared to only AC (OR 1.80, 95% CI 1.17–2.78). Conclusion There is potential for efficacy and safety benefits in SR/PC use as compared to AC only in AIS-DMVO. Further trials are necessary to validate the efficacy and safety of SR use in AIS-DMVO.
Databáze: OpenAIRE
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