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
{"title":"远端中血管闭塞性卒中的血栓切除术：联合与单一装置技术-系统回顾和荟萃分析。","authors":"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","doi":"10.3389/fstro.2023.1126130","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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; <i>p</i> = 0.021] and FPE (OR, 3.55; 95% CI, 1.97-6.38; <i>p</i> < 0.001), with lower odds of sICH (OR, 0.23; 95% CI 0.06-0.93; <i>p</i> = 0.040). There were no significant differences in final reperfusion, functional independence (OR, 1.19; 95% CI 0.87-1.63; <i>p</i> = 0.658), or mortality (OR, 0.94; 95% CI, 0.50-1.76; <i>p</i> = 0.850).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_recor d.php?ID=CRD42022370160, identifier: CRD42022370160.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"65 1","pages":"1126130"},"PeriodicalIF":0.0000,"publicationDate":"2023-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12802724/pdf/","citationCount":"0","resultStr":"{\"title\":\"Thrombectomy for distal medium vessel occlusion stroke: Combined vs. single-device techniques - A systematic review and meta-analysis.\",\"authors\":\"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\",\"doi\":\"10.3389/fstro.2023.1126130\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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; <i>p</i> = 0.021] and FPE (OR, 3.55; 95% CI, 1.97-6.38; <i>p</i> < 0.001), with lower odds of sICH (OR, 0.23; 95% CI 0.06-0.93; <i>p</i> = 0.040). There were no significant differences in final reperfusion, functional independence (OR, 1.19; 95% CI 0.87-1.63; <i>p</i> = 0.658), or mortality (OR, 0.94; 95% CI, 0.50-1.76; <i>p</i> = 0.850).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_recor d.php?ID=CRD42022370160, identifier: CRD42022370160.</p>\",\"PeriodicalId\":73108,\"journal\":{\"name\":\"Frontiers in stroke\",\"volume\":\"65 1\",\"pages\":\"1126130\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-01-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12802724/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in stroke\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3389/fstro.2023.1126130\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in stroke","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3389/fstro.2023.1126130","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
Thrombectomy for distal medium vessel occlusion stroke: Combined vs. single-device techniques - A systematic review and meta-analysis.
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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