TY - JOUR
T1 - Outcomes of stent retriever versus aspiration-first thrombectomy in ischemic stroke
T2 - A systematic review and meta-analysis
AU - Tsang, C. O.A.
AU - Cheung, I. H.W.
AU - Lau, K. K.
AU - Brinjikji, W.
AU - Kallmes, D. F.
AU - Krings, T.
N1 - Funding Information:
This study was supported by the Health and Medical Research Fund of Hong Kong (01150027).
Funding Information:
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.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - 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.
AB - 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.
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U2 - 10.3174/ajnr.A5825
DO - 10.3174/ajnr.A5825
M3 - Review article
C2 - 30337435
AN - SCOPUS:85056622758
VL - 39
SP - 2070
EP - 2076
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
SN - 0195-6108
IS - 11
ER -