TY - JOUR
T1 - Stent retriever versus direct aspiration thrombectomy for acute large vessel occlusion
T2 - A meta-analysis including 17,556 patients, from MR CLEAN to present
AU - Smith, Eric R.
AU - Bethel, Jacob A.
AU - Smith, Timothy B.
AU - Holden, Grant
AU - Torlak, Furkan
AU - Grimsbo, Matthew
AU - Seifi, Ali
AU - Mascitelli, Justin R.
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
KW - Direct aspiration
KW - Mechanical thrombectomy
KW - Stent retriever
KW - Stroke
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U2 - 10.1016/j.clineuro.2022.107122
DO - 10.1016/j.clineuro.2022.107122
M3 - Article
C2 - 35033791
AN - SCOPUS:85122654571
SN - 0303-8467
VL - 213
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 107122
ER -