First-line thrombectomy strategy for distal and medium vessel occlusions: a systematic review

被引：48

作者：

Bilgin, Cem ^{[1
]}

Hardy, Nicole ^{[2
]}

Hutchison, Kristen ^{[2
]}

Pederson, John Michael ^{[2
,3
]}

Mebane, Alexander ^{[3
]}

Olaniran, Peace ^{[2
]}

Kobeissi, Hassan ^{[4
]}

Kallmes, Kevin M. ^{[2
]}

Fiorella, David ^{[5
]}

Kallmes, David F. ^{[1
]}

Brinjikji, Waleed ^{[1
]}

机构：

[1] Mayo Clin, Dept Radiol, Rochester, MN 55902 USA

[2] Nested Knowledge Inc, St Paul, MN USA

[3] Super Med Experts Inc, St Paul, MN USA

[4] Cent Michigan Univ, Coll Med, Mt Pleasant, MI USA

[5] SUNY Stony Brook, Dept Neurosurg, Stony Brook, NY USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2023年 / 15卷 / 06期

关键词：

thrombectomy; stroke; STENT-RETRIEVER THROMBECTOMY; ACUTE ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; ENDOVASCULAR TREATMENT; CONTACT ASPIRATION; RANDOMIZED-TRIAL; M2; OCCLUSION; RECANALIZATION; PREDICTORS;

D O I：

10.1136/jnis-2022-019344

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background The benefit of mechanical thrombectomy (MT) and efficacy of different first-line MT techniques remain unclear for distal and medium vessel occlusions (DMVOs). In this systematic review, we aimed to compare the performance of three first-line MT techniques in DMVOs. Methods The PubMed database was searched for studies examining the utility of MT in DMVOs (middle cerebral artery M2-3-4, anterior cerebral artery, and posterior cerebral artery). Studies providing data for aspiration thrombectomy (ASP), stent retriever thrombectomy (SR), and combined SR+ASP technique were included. Non-comparative studies were excluded. Safety and efficacy data were collected for each technique. The Nested Knowledge AutoLit platform was utilized for literature search, screening, and data extraction. Pooled data were presented as descriptive statistics. Results 13 studies comprising 2422 MT procedures were identified. The overall successful recanalization rate was 77.0% (1513/1964) for DMVOs. SR+ASP had a successful recanalization rate of 83.7% (297/355), SR had a 75.6% rate (638/844), while ASP alone had a 74.2% rate (386/520). The overall functional independence rate was 51.3% (851/1659) among DMVOs. The ASP alone group had a functional independence rate of 46.9% (219/467), while functional independence rates of the SR and SR+ASP groups were 51.5% (372/723) and 61.7% (174/282), respectively. Finally, the subarachnoid hemorrhage rates were 1.8% (4/217) for the ASP group, 9.3% (26/281) for the SR group, and 11.9% (41/344) for the SR+ASP group. Conclusions Our systematic review supports the proposition that MT is a safe and effective treatment option for DMVOs. Additionally, while the SR+ASP group had consistently high rates of clot clearance and good neurological outcomes, the SR and SR+ASP groups also had higher rates of subarachnoid hemorrhage, highlighting the need for improved DMVO treatment devices.

引用

页码：539 / +

页数：9

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