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Published on: January 18, 2018
First-line thrombectomy strategy for distal and medium vessel occlusions: a systematic review
Cem Bilgin1, Nicole Hardy2, Kristen Hutchison2
1Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA bilgin.cem@mayo.edu.
Insights
Mechanical thrombectomy (MT) is effective for distal and medium vessel occlusions (DMVOs). Combined stent retriever and aspiration thrombectomy (SR+ASP) showed high recanalization and functional independence rates, but also increased hemorrhage risk.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Surgery
Background:
- Mechanical thrombectomy (MT) efficacy for distal and medium vessel occlusions (DMVOs) requires further clarification.
- Comparing first-line MT techniques is crucial for optimizing DMVO treatment.
Approach:
- Systematic review of PubMed-indexed studies on MT for DMVOs (M2-4, ACA, PCA).
- Included studies compared aspiration thrombectomy (ASP), stent retriever thrombectomy (SR), and combined SR+ASP.
- Analyzed safety and efficacy data, excluding non-comparative studies.
Key Points:
- Overall successful recanalization rate for DMVOs was 77.0%.
- SR+ASP achieved 83.7% recanalization; SR 75.6%; ASP 74.2%.
- Functional independence rates were 61.7% for SR+ASP, 51.5% for SR, and 46.9% for ASP.
Conclusions:
- MT is a safe and effective treatment for DMVOs.
- SR+ASP demonstrated superior recanalization and functional outcomes.
- Higher subarachnoid hemorrhage rates in SR and SR+ASP groups necessitate improved device development.
Background:
The benefit of mechanical thrombectomy (MT) and efficacy of different first-line MT techniques remain unclear for distal and medium vessel occlusions (DMVOs). In this systematic review, we aimed to compare the performance of three first-line MT techniques in DMVOs.
Methods:
The PubMed database was searched for studies examining the utility of MT in DMVOs (middle cerebral artery M2-3-4, anterior cerebral artery, and posterior cerebral artery). Studies providing data for aspiration thrombectomy (ASP), stent retriever thrombectomy (SR), and combined SR+ASP technique were included. Non-comparative studies were excluded. Safety and efficacy data were collected for each technique. The Nested Knowledge AutoLit platform was utilized for literature search, screening, and data extraction. Pooled data were presented as descriptive statistics.
Results:
13 studies comprising 2422 MT procedures were identified. The overall successful recanalization rate was 77.0% (1513/1964) for DMVOs. SR+ASP had a successful recanalization rate of 83.7% (297/355), SR had a 75.6% rate (638/844), while ASP alone had a 74.2% rate (386/520). The overall functional independence rate was 51.3% (851/1659) among DMVOs. The ASP alone group had a functional independence rate of 46.9% (219/467), while functional independence rates of the SR and SR+ASP groups were 51.5% (372/723) and 61.7% (174/282), respectively. Finally, the subarachnoid hemorrhage rates were 1.8% (4/217) for the ASP group, 9.3% (26/281) for the SR group, and 11.9% (41/344) for the SR+ASP group.
Conclusions:
Our systematic review supports the proposition that MT is a safe and effective treatment option for DMVOs. Additionally, while the SR+ASP group had consistently high rates of clot clearance and good neurological outcomes, the SR and SR+ASP groups also had higher rates of subarachnoid hemorrhage, highlighting the need for improved DMVO treatment devices.
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