Comparative Effectiveness of Mechanical Thrombectomy Techniques for Large Vessel Occlusion Stroke: A Network Meta-analysis of Randomized Controlled Trials
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Updated: Oct 31, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Annu Gulia1, Manyata Srivastava1, Manabesh Nath2
1Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India.
Background:
Mechanical thrombectomy (MT) is a key intervention for acute ischemic stroke due to large vessel occlusion (LVO). Various MT strategies - stent retriever (SR), aspiration (Asp), and their combination (SR + Asp) - are widely used, but the optimal approach remains unclear.
Objectives:
This network meta-analysis (NMA) aimed to compare the efficacy and safety of these techniques using evidence from randomized controlled trials (RCTs).
Materials And Methods:
A Bayesian NMA was conducted, including RCTs evaluating different MT techniques in LVO-related stroke. The primary outcome was successful recanalization (thrombolysis in cerebral infarction ≥2b) and good functional outcome (modified Rankin Scale ≤2 at 90 days). Secondary outcomes included all-cause mortality at 90 days and symptomatic intracranial hemorrhage (sICH) within 24 h. Odds ratios (ORs) with 95% credible intervals (CrIs) were calculated using a Bayesian random-effects model.
Results:
Twenty-seven RCTs were analyzed. Within the current evidence network, SR demonstrated the highest probability of good functional recovery (OR = 2.27; 95% CrI: 1.72-3.02) and successful recanalization (OR = 13.6; 95% CrI: 3.12-75.0). SR + Asp demonstrated the highest probability of reducing 90-day mortality (OR = 0.771; 95% CrI: 0.638-0.929). Rates of sICH were broadly comparable across thrombectomy strategies, although SR and SR + Asp showed higher estimated odds than standard treatment (ST).
Conclusions:
This NMA suggests that SR thrombectomy has the highest probability of achieving successful recanalization and favourable functional outcomes, whereas combined (SR + Asp) showed the highest probability of reducing mortality within the current evidence network. These probability-based rankings should be interpreted cautiously because they were derived from a heterogeneous network with limited direct head-to-head comparisons. Future adequately powered randomized trials directly comparing thrombectomy strategies are required before definitive recommendations can be made.
