Real-World Recanalization Outcomes of Mechanical Thrombectomy in India: A Systematic Review and Meta-Analysis of...

This systematic review and meta-analysis aimed to study the real-world recanalization rates of mechanical thrombectomy (MT) in Indian stroke patients. A comprehensive literature search of PubMed, Scopus, and Embase was conducted for Indian observational studies on MT published up to September 30, 2024. The studies assessing recanalization using the modified thrombolysis in cerebral infarction (mTICI) met the inclusion criteria for review. Besides, only the studies that defined successful recanalization as mTICI ≥2b were included in the meta-analysis. Data on MT techniques, recanalization rates, number of passes, and first-pass effect were extracted. Risk of bias assessment was done using the MINORS tool. Meta-analysis was performed with a random-effects model. Heterogeneity was measured with I ² statistic, and publication bias was assessed via Egger's test. Subgroup and sensitivity analyses were also conducted to address heterogeneity and test the strength of our pooled estimates. Nineteen studies were included in our review out of which 15 retrospective studies entered the primary meta-analysis. The pooled recanalization rate was 80.7% (95% CI: 74.7-86.8%; I ²  = 88.76%). We performed a sensitivity analysis after excluding two outlier studies which reduced heterogeneity ( I ²  = 71.99%) significantly and increased the pooled rate to 82.1%. In the stent retriever subgroup, the pooled recanalization rate after sensitivity analysis was 80.9%. The overall pooled first-pass recanalization rate was 46.8%, and the same was 46.0% for stent retriever-only cases. Due to methodological heterogeneity and scarce data, pooled analyses for aspiration and combined techniques, posterior circulation strokes, and tandem occlusions could not be performed. MT in Indian stroke patients results in successful recanalization rates comparable to global data. We need further well-designed prospective studies for standardized outcomes, especially for contact aspiration technique, which has a potential to be the cost-effective first-line strategy for developing countries such as India.