First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis. Issue 3 (June 2019)

• Record Type: Journal Article
• Authors: Boulanger, Marion; Lapergue, Bertrand; Turjman, Francis; Touzé, Emmanuel; Anxionnat, René; Bracard, Serge; Piotin, Michel; Gory, Benjamin
• Is Part Of: Interventional neuroradiology. Volume 25:Issue 3(2019:Jun.)
• Page Start: 244
• Page End: 253
• Publication Date: 2019-06
• Subjects: Endovascular treatment -- ischemic stroke -- meta-analysis -- thrombectomy; Nervous system -- Interventional radiology -- Periodicals; Nervous system -- Radiography -- Periodicals; Nervous System Diseases -- Periodicals -- radiography; Neuroradiography -- Periodicals; Radiography, Interventional -- Periodicals; Nervous system -- Radiography; Periodicals; 617.4805
• DOI: 10.1177/1591019918821074
• Languages: English
• ISSNs: 1591-0199

Abstract

Background: In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. Purpose: The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion. Methods: We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. We determined rates of final complete reperfusion (defined as modified Thrombolysis In Cerebral Infarction score = 3), periprocedural complications and 90-day functional independence (defined as modified Rankin Scale (mRS) score 0–2), and excellent outcome (defined as mRS score 0–1) after contact aspiration and after stent-retriever thrombectomy using random-effects meta-analyses. Any differential effects in rates between the two strategies were assessed using random-effects meta-regressions. Results: Fifteen studies (1817 patients) were included. There was no difference in rates of final complete reperfusion at the end of all endovascular procedures between contact aspiration and stent retrievers (51.1%, 95% confidence interval (CI) 39.3–62.9; vs 38.3%, 95% CI 28.6–48.0; p int = 0.14), 90-day functional independence (45.0%, 40.7–49.2; vs 52.4%, 47.7–57.1; p int = 0.45) and excellent outcome (32.1%, 25.7–38.5; vs 34.1%, 21.2–46.9; p int = 0.94). Rates of periprocedural complications did not differ between the two strategies. Conclusions: Current data suggest no difference in efficacy and safety between first-line contact aspiration and stent-retriever thrombectomy in stroke patients with large-artery occlusion.