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Abstract WMP89: Mechanical Thrombectomy For Distal Medium-vessel Occlusion Stroke: Systematic Review And Meta-analysis
Abstract   Peer reviewed

Abstract WMP89: Mechanical Thrombectomy For Distal Medium-vessel Occlusion Stroke: Systematic Review And Meta-analysis

Aaron Rodriguez-Calienes, Milagros Galecio-Castillo, Juan Vivanco-Suarez, Cynthia Zevallos Mau, Mudassir Farooqui and Santiago Ortega-Gutierrez
Stroke (1970), Vol.54(Suppl. 1), p.AWMP89
02/01/2023
DOI: 10.1161/str.54.suppl_1.WMP89

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Abstract

Byline: Aaron Rodriguez-Calienes, Univ of Iowa, Iowa city, IA; Milagros Galecio-Castillo, Univ of Iowa, Iowa City, IA; Juan Vivanco-Suarez, Univ of Iowa, Iowa City, IA; Cynthia Zevallos Mau, Univ of Iowa, Iowa City, IA; Mudassir Farooqui, Univ of Iowa, Iowa City, IA; Santiago Ortega-Gutierrez, Univ of Iowa, Iowa City, IA Introduction: Definitive evidence about the role and effectiveness of mechanical thrombectomy (MT) in patients with distal medium-vessel occlusions (DMVOs) is limited. Objective: To determine the efficacy and safety of MT for DMVOs. Methods: A systematic search was performed until May 2022 in Scopus, Embase, Medline, Web of Science, and Cochrane. An additional cohort of 33 patients from our institutional experience was also included. Primary efficacy and safety outcomes were successful reperfusion (mTICI 2b-3) and sICH, respectively. Additional outcomes were the rate of complete reperfusion (mTICI 3), 90-day excellent and favorable functional outcome (defined as an mRS of 0-1 and 0-2, respectively), and 90-day mortality. We conducted meta-analyses using random-effects models and assessed the certainty of evidence using the GRADE approach. Statistical heterogeneity across studies was assessed with I2 statistics. Results: A total of 24 studies with 1046 patients were included in our analysis. Successful and complete reperfusion rates were 89.8% (95% CI 83.7-93.7%; I2=0%; moderate-certainty evidence) and 47.2% (95% CI 32.3-62.5%; I2=75%; very low-certainty evidence), respectively. Favorable and excellent functional outcome rates were 59.1% (95% CI 48.4-68.9%; I2=73%; moderate-certainty evidence) and 43% (95% CI 32.9-53.7%; I2=68%; low-certainty evidence), respectively. Mortality and sICH rates were 12.4% (95% CI 9.3-16.5%; I2=16%; high-certainty evidence) and 5.5% (95% CI 3.5-8.5%; I2=23%; moderate-certainty evidence), respectively. Conclusion: This systematic review with meta-analysis found that MT for DMVO provides rates of successful reperfusion and sICH comparable to the evidence from MT for LVO stroke and M2 occlusions. Given the level of evidence of our results, further confirmation on well-designed RCTs is needed.

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