TY - JOUR
T1 - Direct Aspiration versus Stent Retriever Thrombectomy for Acute Stroke
T2 - A Systematic Review and Meta-Analysis in 9127 Patients
AU - Primiani, Christopher T.
AU - Vicente, Angel Chinea
AU - Brannick, Michael T.
AU - Turk, Aquilla S.
AU - Mocco, J.
AU - Levy, Elad I.
AU - Siddiqui, Adnan H.
AU - Mokin, Maxim
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/5
Y1 - 2019/5
N2 - Background: The two most common approaches to thrombectomy of emergent large vessel occlusion (direct aspiration and primary stent retriever thrombectomy) have been extensively studied; however, the detailed benefit and risk comparison is largely unknown. Objective: To conduct a systematic review and meta-analysis to compare radiographic and clinical outcomes between the use of primary stent retrievers and direct aspiration in management of acute ischemic stroke. Methods: PubMed database was searched for studies between September 1, 2012 and December 31, 2017 with acute ischemic stroke patients. Results: We identified 64 studies with 6875 patients in the primary stent retriever group and 25 studies with 2252 patients in the aspiration group. Primary aspiration alone, without the need of rescue stent retriever devices within the aspiration cohort, was performed in 65% of 2252 patients. There was no difference in the distribution of emergent large vessel occlusion based on occlusion site, age, baseline National Institutes of Health Stroke Scale, or the use of intravenous tPA (P =.19,.051,.23, and.093, respectively). Successful recanalization rates, defined as thrombolysis in cerebral Infarction 2b/3, were significantly higher in the aspiration group than the primary stent retriever group (89% versus 80%, P <.0001). No significant difference in good clinical outcome, defined as modified Rankin scale 0-2 (aspiration 52% versus stent 48%, P =.13), symptomatic intracerebral hemorrhage (aspiration 5.6% versus stent 7.2%, P =.07), and mortality at 3 months (aspiration 15% versus stent 19%, P =.10). Conclusions: Both aspiration-first (including the subsequent use of stent retriever) and primary stent retriever thrombectomy approaches are equally effective in achieving good clinical outcomes. Our study suggests that direct aspiration with or without subsequent use of stent retriever is a safe and effective alternative to primary stent retriever in acute ischemic stroke.
AB - Background: The two most common approaches to thrombectomy of emergent large vessel occlusion (direct aspiration and primary stent retriever thrombectomy) have been extensively studied; however, the detailed benefit and risk comparison is largely unknown. Objective: To conduct a systematic review and meta-analysis to compare radiographic and clinical outcomes between the use of primary stent retrievers and direct aspiration in management of acute ischemic stroke. Methods: PubMed database was searched for studies between September 1, 2012 and December 31, 2017 with acute ischemic stroke patients. Results: We identified 64 studies with 6875 patients in the primary stent retriever group and 25 studies with 2252 patients in the aspiration group. Primary aspiration alone, without the need of rescue stent retriever devices within the aspiration cohort, was performed in 65% of 2252 patients. There was no difference in the distribution of emergent large vessel occlusion based on occlusion site, age, baseline National Institutes of Health Stroke Scale, or the use of intravenous tPA (P =.19,.051,.23, and.093, respectively). Successful recanalization rates, defined as thrombolysis in cerebral Infarction 2b/3, were significantly higher in the aspiration group than the primary stent retriever group (89% versus 80%, P <.0001). No significant difference in good clinical outcome, defined as modified Rankin scale 0-2 (aspiration 52% versus stent 48%, P =.13), symptomatic intracerebral hemorrhage (aspiration 5.6% versus stent 7.2%, P =.07), and mortality at 3 months (aspiration 15% versus stent 19%, P =.10). Conclusions: Both aspiration-first (including the subsequent use of stent retriever) and primary stent retriever thrombectomy approaches are equally effective in achieving good clinical outcomes. Our study suggests that direct aspiration with or without subsequent use of stent retriever is a safe and effective alternative to primary stent retriever in acute ischemic stroke.
KW - ADAPT
KW - Stent
KW - aspiration
KW - endovascular
KW - stroke
KW - thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85061373484&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2019.01.034
DO - 10.1016/j.jstrokecerebrovasdis.2019.01.034
M3 - Article
C2 - 30772159
AN - SCOPUS:85061373484
SN - 1052-3057
VL - 28
SP - 1329
EP - 1337
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 5
ER -