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

Abstract

PurposeThe 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 MethodsStudy 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.ResultsHypertension 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).ConclusionBoth 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.

ADAPT technique in ischemic stroke treatment of M2 middle cerebral artery occlusions in comparison to M1 occlusions: Post hoc analysis of the PROMISE study

“…A recently published meta-analysis comparing contact aspiration to stent-retriever thrombectomy on MCA-M2 occlusions reported a lower rate of sICH in the aspiration group (2.6%) compared to the stent-retriever group (5.7%) but without statistical significance ( p = 0.18). 38 The recent development of the latest generation of large-bore catheters with improved trackability and better navigation requiring fewer manipulations may contribute to the favorable safety profile found in our study. These trends should be further assessed in a prospective randomized trial setting.…”

A review of endovascular treatment for medium vessel occlusion stroke

“…Furthermore, the literature on MeVO EVT techniques is biased, with onset-to-treatment times being on average much shorter in studies that used primary aspiration compared with those in which stent retrievers were used. 38 Of note, MeVO EVT techniques and technologies are constantly evolving, and with MeVOs increasingly being targeted by neurointerventionalists, it is likely that treatment devices that are specifically tailored to MeVOs will be developed in the near future. A substantial number of LVOs are treated without the use of general anesthesia (GA).…”

Direct aspiration stroke thrombectomy: a comprehensive review

“…Similar results have been reported in studies focusing on patients with proximal M2 occlusions only (three observational studies and two meta-analyses) (see table 3). [54][55][56][57][58] It should be noted that several of the aforementioned studies included patients before 2015, at a time when MT was not yet standard of care; thus these studies reflect data accrued with older generations of devices, with older techniques and without the rigorous patient selection criteria responsible for the great success in recent trials. Furthermore, these early studies were plagued with a significant heterogeneity in thrombectomy technique which confounds comparison between SR and DA.…”