Enver De Wei Loh, Gabriel Yi Ren Kwok, Keith Zhi Xian Toh, Ming Yi Koh, Yao Hao Teo, Yao Neng Teo, Bernard P L Chan, Vijay Kumar Sharma, Megan Bi-Jia Ng, Hui Shi Lim, Betsy Soon, Anil Gopinathan, Cunli Yang, Ching-Hui Sia, Pervinder Bhogal, Patrick A Brouwer, Lukas Meyer, Jens Fiehler, Tommy Andersson, Benjamin Y Q Tan, Leonard L L Yeo
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引用次数: 0
Abstract
Background: The optimal mechanical thrombectomy technique for acute ischaemic stroke (AIS) caused by distal, medium vessel occlusion (DMVO) is uncertain. We performed a systematic review and meta-analysis evaluating the efficacy and safety of first-line thrombectomy with combined techniques, which entail simultaneous use of a stent retriever and aspiration catheter, vs. single-device techniques, whether stent retriever or direct aspiration alone, for DMVO-AIS patients.
Methods: We systematically searched the PubMed, Embase and Cochrane CENTRAL databases from inception until 2 September 2022 for studies comparing combined and single-device techniques in DMVO-AIS patients. We adopted the Distal Thrombectomy Summit Group's definition of DMVO. Our outcomes were the modified first-pass effect [mFPE; modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 at first-pass], first-pass effect (FPE; mTICI 2c-3 at first-pass), successful and complete final reperfusion (mTICI 2b-3 and 2c-3 at end of all procedures, respectively), 90-day functional independence (modified Rankin scale 0-2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH).
Results: Nine studies were included, with 477 patients receiving combined techniques, and 670 patients receiving single-device thrombectomy. Combined techniques achieved significantly higher odds of mFPE [odds ratio (OR), 2.12; 95% confidence interval (CI), 1.12-4.02; p = 0.021] and FPE (OR, 3.55; 95% CI, 1.97-6.38; p < 0.001), with lower odds of sICH (OR, 0.23; 95% CI 0.06-0.93; p = 0.040). There were no significant differences in final reperfusion, functional independence (OR, 1.19; 95% CI 0.87-1.63; p = 0.658), or mortality (OR, 0.94; 95% CI, 0.50-1.76; p = 0.850).
Conclusions: In DMVO-AIS patients, mechanical thrombectomy combining stent retrievers and aspiration catheters achieved higher odds of FPE and lower odds of sICH over single-device techniques. There were no differences in functional independence and mortality. Further trials are warranted to establish these findings.
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