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Updated: Aug 9, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke: systematic
Aaron Rodriguez-Calienes1,2, Juan Vivanco-Suarez1, Joel M Sequeiros3
1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Background:
There is limited evidence on the indication and role of mechanical thrombectomy (MT) in patients with distal medium-vessel occlusions (DMVOs). The aim of this systematic review and meta-analysis was to evaluate all the evidence available on the efficacy and safety of MT techniques (stent retriever, aspiration) in primary and secondary DMVOs.
Methods:
Five databases were searched from inception to January 2023 for studies of MT in primary and secondary DMVOs. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0-2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Prespecified subgroup meta-analyses according to the specific MT technique and to the vascular territory (distal M2-M5, A2-A5, P2-P5) were also performed.
Results:
A total of 29 studies with 1262 patients were included. For primary DMVOs (n=971 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 84% (95% confidence interval (CI) 76 to 90%), 64% (95% CI 54 to 72%), 12% (95% CI 8 to 18%), and 6% (95% CI 4 to 10%), respectively. For secondary DMVOs (n=291 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 82% (95% CI 73 to 88%), 54% (95% CI 39 to 69%), 11% (95% CI 5 to 20%), and 3% (95% CI 1 to 9%), respectively. Subgroup analyses by MT technique and by vascular territory showed no differences in primary and secondary DMVOs.
Conclusion:
Our findings suggest that MT using aspiration or stent retriever techniques appears to be effective and safe in primary and secondary DMVOs. However, given the level of evidence of our results, further confirmation in well-designed randomized controlled trials is needed.
Insights
Mechanical thrombectomy (MT) is effective for distal medium-vessel occlusions (DMVOs). This review found MT techniques like aspiration and stent retrievers safe and beneficial for primary and secondary DMVOs, though further trials are needed.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Limited evidence exists regarding the efficacy and safety of mechanical thrombectomy (MT) for distal medium-vessel occlusions (DMVOs).
- This systematic review and meta-analysis aimed to consolidate existing data on MT for primary and secondary DMVOs.
Approach:
- A comprehensive search of five databases was conducted up to January 2023.
- Studies involving MT for primary and secondary DMVOs were analyzed for outcomes including functional outcome, reperfusion rates, symptomatic intracerebral hemorrhage, and mortality.
- Subgroup analyses were performed based on MT technique and affected vascular territory.
Key Points:
- In primary DMVOs (971 patients), MT achieved 84% reperfusion, 64% favorable functional outcome, 12% mortality, and 6% symptomatic intracerebral hemorrhage.
- In secondary DMVOs (291 patients), MT showed 82% reperfusion, 54% favorable outcome, 11% mortality, and 3% symptomatic intracerebral hemorrhage.
- No significant differences were observed between MT techniques or across different distal vascular territories.
Conclusions:
- Mechanical thrombectomy using aspiration or stent retriever techniques demonstrates efficacy and safety in treating both primary and secondary distal medium-vessel occlusions.
- High-quality randomized controlled trials are necessary to further validate these findings and establish definitive treatment guidelines.
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