Stent retriever versus direct aspiration thrombectomy for acute large vessel occlusion: A meta-analysis including 17,556 patients, from MR CLEAN to present

Eric R. Smith, Jacob A. Bethel, Timothy B. Smith, Grant Holden, Furkan Torlak, Matthew Grimsbo, Ali Seifi, Justin R. Mascitelli

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: Stent retriever (SR) and direct aspiration (DA) mechanical thrombectomy (MT) improve clinical outcomes for stroke secondary to large vessel occlusion. The purpose is to perform an updated meta-analysis comparing the two techniques. Methods: PubMed database was searched for studies between January 1, 2015, and July 5th, 2021 with mechanical thrombectomy to treat acute ischemic stroke. Results: We identified 136 studies including 17,556 patients, with 11,258 (64.1%) patients treated by SR or a combined approach and 6298 (35.9%) patients with DA. The DA group had less posterior cerebral artery strokes, was significantly older, and had lower National Institutes of Health Stroke Scale scores (p = .05,.02,.04) There was no difference between groups in percentage of middle cerebral artery or internal carotid artery occlusions or intravenous tissue plasminogen activator administered (p = .62,.19,.06). A regression model showed no difference between SR and DA in mortality, symptomatic intracranial hemorrhage, and disability (mRS > 2) at 90 days (p = .13,.75,.84). Successful reperfusion (mTICI 2b/3 rates) were higher in the DA group (DA 87.6% vs SR 82.3%, p < .01), but after accounting for covariates was not significant (p = .17). Conclusion: Our updated meta-analysis shows that DA has similar safety, reperfusion and 90-day clinical outcomes compared to SR. These results should serve to increase confidence in DA thrombectomy for acute ischemic stroke secondary to LVO.

Original languageEnglish (US)
Article number107122
JournalClinical Neurology and Neurosurgery
Volume213
DOIs
StatePublished - Feb 2022

Keywords

  • Direct aspiration
  • Mechanical thrombectomy
  • Stent retriever
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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