Endovascular thrombectomy for acute ischemic stroke with primary occlusion of the anterior cerebral artery: A meta-analysis

Background

Anterior cerebral artery (ACA) occlusions account for up to 4 % of all acute ischemic strokes and may lead to debilitating outcomes. While endovascular thrombectomy (EVT) is a well-established treatment for large vessel occlusions, its efficacy and safety for primary ACA occlusions remains unclear. This systematic review and meta-analysis aims to address this gap by evaluating the clinical outcomes, safety, and efficacy of EVT in the treatment for primary ACA occlusions.

Methods

Following PRISMA guidelines, five databases were queried from database inception until April 2024 for studies describing the use of EVT for acute ischemic primary ACA occlusions. Following abstract, title, and full text-screening, data on patient demographics, clinical presentation, procedural details, and surgical outcomes were extracted from included articles. Primary outcomes were successful reperfusion (modified-Treatment in Cerebral Infarction (mTICI) score 2b-3), and favorable functional outcomes (3-month modified Rankin Scale (mRS) scores 0-2). Secondary outcomes included 3-month mortality rates and procedural complication rates. Meta-analysis was performed using a random-effects model, with heterogeneity assessed by the Higgins index (I²>50 %).

Results

Ten studies met eligibility criteria, encompassing a total of 265 patients with complete clinical and outcome data. Across the pooled meta-analysis, the rate of successful reperfusion (mTICI ≥ 2b) was 0.78 (95 % CI: 0.67-0.86) and the rate of 3-month mRS score 0-2 was 0.41 (95 % CI: 0.33-0.51). Pooled meta-analysis of secondary outcomes analysis revealed a 3-month mortality rate of 0.20 (95 % CI: 0.15-0.26), while the rate of symptomatic intracerebral hemorrhage was 0.04 (95 % CI: 0.02-0.08).

Conclusion

Our findings demonstrate that while successful reperfusion can be achieved with low complication rates, primary ACA occlusions treated with EVT are associated with high morbidity and mortality.