Primary suction thrombectomy for acute ischemic stroke: A meta-analysis of the current literature

We conducted a meta-analysis to assess the angiographic and clinical outcomes for ischemic stroke patients treated with primary suction thrombectomy and to compare the procedural outcomes based on the treatment strategies (primary suction vs. stent retriever thrombectomy).

We conducted a systemic literature review through an online data base from January 2004 through December 2016. The primary outcomes were rate of successful recanalization on final angiogram and good outcome three months after stroke onset. We used a fixed-effect model in cases with heterogeneity <50%.

Fifteen articles were included. Primary suction thrombectomy achieved a successful recanalization rate of 85.2% (95% confidence interval [CI]: 79.9%-89.3%), a good clinical outcome rate of 52.7% (95% CI: 49.3%-56.2%) after the three-month follow-up, a mortality rate of 13.0% (95% CI: 8.9%-18.5%) and a symptomatic intracranial hemorrhage rate of 6.2% (95% CI: 4.8%-8.0%). The rates of recanalization (odds ratio [OR], 1.064; 95% CI: 0.202-5.608; p=0.571) and good outcomes (OR, 0.920; 95% CI: 0.570-1.486; p=0.735) did not differ significantly between primary suction thrombectomy and stent retriever thrombectomy.

Primary suction thrombectomy produced higher recanalization and good clinical outcome rates than did stent retriever thrombectomy. Larger-scale studies are necessary that consider factors such as occlusion site, stroke severity, and concomitant use of endovascular devices.