Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis

Purpose The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus...

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Main Authors: Kevin Phan, Julian Maingard, Hong Kuan Kok, Adam A Dmytriw, Sourabh Goyal, Ronil Chandra, Duncan Mark Brooks, Vincent Thijs, Hamed Asadi
Format: Article
Language:English
Published: Korean Society of Interventional Neuroradiology 2018-09-01
Series:Neurointervention
Subjects:
Online Access:http://neurointervention.org/upload/pdf/neuroint-2018-00997.pdf
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spelling doaj-17f5d86fc9d8441680410b8b33f7eab12020-11-25T02:30:44ZengKorean Society of Interventional NeuroradiologyNeurointervention2093-90432233-62732018-09-0113210010910.5469/neuroint.2018.00997239Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-AnalysisKevin Phan0Julian Maingard1Hong Kuan Kok2Adam A Dmytriw3Sourabh Goyal4Ronil Chandra5Duncan Mark Brooks6Vincent Thijs7Hamed Asadi8 NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Randwick, Australia Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia Department of Interventional Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Department of Radiology, University of Toronto, Toronto, Canada NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Randwick, Australia Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Australia Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, Australia Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Heidelberg, AustraliaPurpose The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus contact aspiration for M2 occlusions. Materials and Methods Study selection included cohorts of patients with distal MCA occlusions in acute ischemic strokes treated with an endovascular approach including stent-retrieval or contact aspiration. Twelve studies were selected for meta-analysis for a total of 835 cases. Meta-analysis by proportions was conducted on parameters including baseline and procedural characteristics, thrombolysis in cerebral infarction (TICI) 2b–3 outcomes, and 90-day modified Rankin scale (mRS) outcomes. Results Hypertension and hyperlipidemia were more prevalent in stent-retriever patients. Pooled baseline National Institute of Health Stroke Scale scores and Alberta Stroke Program Early Computed Tomography Score imaging scores were similar. Pooled time onset of symptoms to door arrival was higher for the stent-retrieval group (154 vs. 97.4 minutes, P=0.01), as was time to groin puncture (259.9 vs. 156.2 minutes, P=0.02), but there was no difference in procedure time. The TICI 2b–3 recanalization rate was similar (80.5% vs. 86.8%, P=0.168). The frequency of mRS 0–2 at 90-day was also similar (74.5% vs. 59.9%, P=0.120), and an excellent mRS 0–1 was lower for stent-retrievers (39.9% vs. 65.6%, P=0.003). A significant negative correlation was found between onset to groin puncture time and the proportion of patients with a good mRS (r=-0.71, P=0.048). Conclusion Both endovascular techniques achieved recanalization rates greater than 80% and 90-day outcomes of minimal disability with similar complication rates. The literature is skewed by aspiration cases being performed sooner after onset of stroke compared to stent-retriever cases.http://neurointervention.org/upload/pdf/neuroint-2018-00997.pdfcerebrovascular disordersischemiastrokethrombectomyendovascular proceduresmiddle cerebral artery
collection DOAJ
language English
format Article
sources DOAJ
author Kevin Phan
Julian Maingard
Hong Kuan Kok
Adam A Dmytriw
Sourabh Goyal
Ronil Chandra
Duncan Mark Brooks
Vincent Thijs
Hamed Asadi
spellingShingle Kevin Phan
Julian Maingard
Hong Kuan Kok
Adam A Dmytriw
Sourabh Goyal
Ronil Chandra
Duncan Mark Brooks
Vincent Thijs
Hamed Asadi
Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis
Neurointervention
cerebrovascular disorders
ischemia
stroke
thrombectomy
endovascular procedures
middle cerebral artery
author_facet Kevin Phan
Julian Maingard
Hong Kuan Kok
Adam A Dmytriw
Sourabh Goyal
Ronil Chandra
Duncan Mark Brooks
Vincent Thijs
Hamed Asadi
author_sort Kevin Phan
title Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis
title_short Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis
title_full Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis
title_fullStr Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis
title_full_unstemmed Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis
title_sort contact aspiration versus stent-retriever thrombectomy for distal middle cerebral artery occlusions in acute ischemic stroke: meta-analysis
publisher Korean Society of Interventional Neuroradiology
series Neurointervention
issn 2093-9043
2233-6273
publishDate 2018-09-01
description Purpose The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus contact aspiration for M2 occlusions. Materials and Methods Study selection included cohorts of patients with distal MCA occlusions in acute ischemic strokes treated with an endovascular approach including stent-retrieval or contact aspiration. Twelve studies were selected for meta-analysis for a total of 835 cases. Meta-analysis by proportions was conducted on parameters including baseline and procedural characteristics, thrombolysis in cerebral infarction (TICI) 2b–3 outcomes, and 90-day modified Rankin scale (mRS) outcomes. Results Hypertension and hyperlipidemia were more prevalent in stent-retriever patients. Pooled baseline National Institute of Health Stroke Scale scores and Alberta Stroke Program Early Computed Tomography Score imaging scores were similar. Pooled time onset of symptoms to door arrival was higher for the stent-retrieval group (154 vs. 97.4 minutes, P=0.01), as was time to groin puncture (259.9 vs. 156.2 minutes, P=0.02), but there was no difference in procedure time. The TICI 2b–3 recanalization rate was similar (80.5% vs. 86.8%, P=0.168). The frequency of mRS 0–2 at 90-day was also similar (74.5% vs. 59.9%, P=0.120), and an excellent mRS 0–1 was lower for stent-retrievers (39.9% vs. 65.6%, P=0.003). A significant negative correlation was found between onset to groin puncture time and the proportion of patients with a good mRS (r=-0.71, P=0.048). Conclusion Both endovascular techniques achieved recanalization rates greater than 80% and 90-day outcomes of minimal disability with similar complication rates. The literature is skewed by aspiration cases being performed sooner after onset of stroke compared to stent-retriever cases.
topic cerebrovascular disorders
ischemia
stroke
thrombectomy
endovascular procedures
middle cerebral artery
url http://neurointervention.org/upload/pdf/neuroint-2018-00997.pdf
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