Journal article
Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke: systematic review and meta-analysis
Journal of neurointerventional surgery, Vol.15(e3), pp.e460-e467
12/2023
DOI: 10.1136/jnis-2022-019975
PMID: 36797050
Abstract
BackgroundThere is limited evidence on the indication and role of mechanical thrombectomy (MT) in patients with distal medium-vessel occlusions (DMVOs). The aim of this systematic review and meta-analysis was to evaluate all the evidence available on the efficacy and safety of MT techniques (stent retriever, aspiration) in primary and secondary DMVOs.MethodsFive databases were searched from inception to January 2023 for studies of MT in primary and secondary DMVOs. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0–2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Prespecified subgroup meta-analyses according to the specific MT technique and to the vascular territory (distal M2-M5, A2-A5, P2-P5) were also performed.ResultsA total of 29 studies with 1262 patients were included. For primary DMVOs (n=971 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 84% (95% confidence interval (CI) 76 to 90%), 64% (95% CI 54 to 72%), 12% (95% CI 8 to 18%), and 6% (95% CI 4 to 10%), respectively. For secondary DMVOs (n=291 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 82% (95% CI 73 to 88%), 54% (95% CI 39 to 69%), 11% (95% CI 5 to 20%), and 3% (95% CI 1 to 9%), respectively. Subgroup analyses by MT technique and by vascular territory showed no differences in primary and secondary DMVOs.ConclusionOur findings suggest that MT using aspiration or stent retriever techniques appears to be effective and safe in primary and secondary DMVOs. However, given the level of evidence of our results, further confirmation in well-designed randomized controlled trials is needed.
Details
- Title: Subtitle
- Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke: systematic review and meta-analysis
- Creators
- Aaron Rodriguez-Calienes - University of Iowa Hospitals and ClinicsJuan Vivanco-Suarez - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAJoel M Sequeiros - University of Tennessee Health Science CenterMilagros Galecio-Castillo - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USACynthia B Zevallos - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMudassir Farooqui - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASantiago Ortega-Gutierrez - Department of Neuroloy, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.15(e3), pp.e460-e467
- Publisher
- BMJ Publishing Group Ltd
- DOI
- 10.1136/jnis-2022-019975
- PMID
- 36797050
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Language
- English
- Electronic publication date
- 02/16/2023
- Date published
- 12/2023
- Academic Unit
- Neurology; Radiology; Neurosurgery
- Record Identifier
- 9984367615502771
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