Safety and Efficacy of Mechanical Thrombectomy Using Stent Retrievers in the Endovascular Treatment of Acute Ischaemic Stroke: A Systematic Review

Abstract

Background:The treatment of choice for acute ischaemic stroke is the intravenous administration of recombinant tissue plasminogen activator within 3-4.5 h of symptom onset. However, the use of a thrombolytic would be limited by its narrow therapeutic window and contraindications. As a result, in recent years, techniques such as mechanical thrombectomy have emerged, which employ thrombus retrieval devices, such as stent retrievers (Solitaire TM , Trevo ® or Revive TM ), whose safety and efficacy in the endovascular treatment of acute ischaemic stroke is analysed in this article. Methods: A systematic literature search was undertaken until March 2015. The quality of evidence was assessed according to the GRADE methodology. A meta-analysis of the results of randomised controlled trials (RCTs) was performed, and the weighted average for the case series' sample size was calculated (Review Manager v5.2 and SPSS v19). Results: Seventeen primary studies (2 RCTs, Solitaire TM and Trevo ® vs.Merci ® , and 15 case series) were selected. The RCT results show that stent retrievers have a safety profile similar to the Merci ® device. However, both Solitaire TM and Trevo ® achieved a higher recanalisation success rate (OR, 4.56; 95% CI, 2.63-7.90; p < 0.00001) and appropriate clinical outcome at 90 days (OR, 2.54; 95% CI, 1.52-4.25; p < 0.0004), although the 90-day mortality rate was similar in both groups (OR, 0.75; 95% CI, p = 0.70). Conclusions: Stent retrievers appear to be safe and effective devices, achieving high recanalisation rates and good clinical outcomes in the endovascular treatment of patients with acute ischaemic stroke due to the occlusion of intracranial arteries in comparison with the clot retriever Merci ® .

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

“…In 2014 and from 2016 to 2018, the success rate at our center is in the range of 83-86%. Recent literature comes to similar success rates of around 80-89% [6,16], while older reviews indicate success rates of 80% [17].…”

Stent Retrievers for the Treatment of Acute Ischemic Stroke

“…These previous reviews are limited by the use of nonrandomized data and thus may be affected by confounding by indication and other variables. Another recent systematic review and metaanalysis 17 included only 2 RCTs comparing stent retrievers with the first-generation Merci coil retriever and none of the recently published stent-retriever RCTs. Although data were pooled in a commentary written by Goyal and Menon 18 that examined the 5 acute endovascular RCTs published in 2015, their meta-analysis was conducted outside the context of a systematic review.…”

Comparison of the efficacy and safety of thrombectomy devices in acute stroke : a network meta-analysis of randomized trials

“…The second-generation stent retrievers Solitaire and Trevo are self-expanding stents that trap the thrombus against the vessel wall and can be retrieved via catheter 9–11. A meta-analysis of 17 primary studies showed that stent retrievers (both Trevo and Solitaire) have superior revascularization rates and clinical outcomes with a similar safety profile to the Merci device 12. Additionally, a meta-analysis of 19 studies comparing Trevo and Solitaire devices showed similar efficacy and safety except for higher mortality rates with the Trevo device 13…”