Thrombectomy for Distal Medium Vessel Occlusion: A Meta-Analysis of Randomized Controlled Trials

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• Distal medium vessel occlusions account for 25-40% of acute ischemic strokes.
• The efficacy and safety of thrombectomy for these occlusions remain unclear.

Purpose of the Study:

• To systematically evaluate the effectiveness and safety of thrombectomy in patients with distal medium vessel occlusions.
• To assess functional outcomes, intracranial hemorrhage, and mortality following thrombectomy compared to medical management.

Main Methods:

• Systematic search of PubMed, Cochrane, and Embase for randomized controlled trials.
• Primary outcomes: functional outcomes (excellent, good, favorable) at 90 days.
• Secondary outcomes: symptomatic intracranial hemorrhage (ICH), any ICH, and mortality at 90 days.

Main Results:

• No significant difference in excellent (OR 0.92), good (OR 0.87), or favorable (OR 0.84) functional outcomes at 3 months.
• Thrombectomy significantly increased symptomatic ICH (OR 2.18) and any ICH (OR 1.96).
• Mortality at 3 months was similar between thrombectomy and medical management groups (OR 1.20).

Conclusions:

• Thrombectomy does not improve functional outcomes or reduce mortality in distal medium vessel occlusions.
• Thrombectomy is associated with an increased risk of intracranial hemorrhage.
• Further research is needed to identify patient subgroups who may benefit from thrombectomy.