Should the direct aspiration first pass technique be advocated over the stent-retriever technique for acute ischemic stroke? A systematic review and meta-analysis of 7692 patients

Negida, Ahmed; Ghaith, Hazem S.; Gabra, Mohamed Diaa; Aziz, Mohamed Abdelalem; Elfil, Mohamed; Al-Shami, Haider; Bahbah, Eshak I.; Kanmounye, Ulrick Sidney; Raslan, Ahmed M.

doi:10.25259/sni_903_2021

Cited by 6 publications

(10 citation statements)

References 45 publications

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“…Study characteristics, consisting of the publication date, journal, number of included studies, last literature search date, and number of direct aspiration and stent retriever patients, are presented in table 1. The most recent study was conducted by Negida et al 13 (December 2021), while the earliest was conducted by Phan et al 14 (July 2018). Negida et al 13 also had the highest number of included studies (n=30), followed by Phan et al ,14 Zhang et al ,18 and Texakalidis et al 16 (n=22, 20, and 19, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…The most recent study was conducted by Negida et al 13 (December 2021), while the earliest was conducted by Phan et al 14 (July 2018). Negida et al 13 also had the highest number of included studies (n=30), followed by Phan et al ,14 Zhang et al ,18 and Texakalidis et al 16 (n=22, 20, and 19, respectively). The breakdown of primary studies included in each meta-analysis is presented in online supplemental table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Randomized controlled trials, observational studies, and meta-analyses have compared the outcomes of patients with LVO AIS treated by ADAPT and stent retrievers 12–20. However, these studies have inconsistent methodologies and data reporting, limiting the ability to accurately assimilate data from different studies that would inform AIS treatment.…”

Section: Introductionmentioning

confidence: 99%

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Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: evaluating the overlapping meta-analyses

Azzam

Ghozy

Kallmes³

et al. 2022

J NeuroIntervent Surg

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BackgroundPrevious studies comparing a direct aspiration first pass technique (ADAPT) and stent retrievers have inconsistent methodologies and data reporting, limiting the ability to accurately assimilate data from different studies that would inform treatment of acute ischemic stroke (AIS) treatment.ObjectiveTo conduct a systematic review to discuss and compare the findings of all relevant meta-analysis studies comparing the efficacy of the ADAPT and stent retriever techniques.MethodsThe study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), where meta-analyses comparing the efficacy of the ADAPT technique and stent retrievers in the treatment of AIS were included. We extracted all relevant data from the included studies and assessed the quality of the included meta-analyses using the Assessment of Multiple Systematic Review (AMSTAR-2).ResultsSeven relevant studies met our inclusion criteria and were suitable for the qualitative synthesis. All included studies obtained data from randomized controlled trials (RCTs) and observational investigations (including levels II, III, and IV). At the same time, none of them used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for quality assessment. In accordance with AMSTAR-2, two studies were rated ‘high’, while the other five were rated ‘moderate’.ConclusionsPresent evidence is insufficient to clarify the superiority of one modality over the other. Further RCTs on this comparison must be conducted prior to designing further meta-analyses or making conclusive interpretations. Procedure duration and cost should be taken into consideration for any future studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: evaluating the overlapping meta-analyses

Azzam

Ghozy

Kallmes³

et al. 2022

J NeuroIntervent Surg

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“…The main limitations were a high percentage of rescue therapy in the ADAPT group (ASTER: 32.8%; COMPASS: 21%) and an uneven distribution of the localization of LVO (ASTER: M2 27.6% in direct aspiration versus 17.6% in the stent retriever cohort). A recent meta-analysis suggested higher recanalization rates with ADAPT [129]. However, this finding was mainly driven by observational data and did not interfere with the outcome overall.…”

Section: Adaptmentioning

confidence: 98%

What You Always Wanted to Know about Endovascular Therapy in Acute Ischemic Stroke but Never Dared to Ask: A Comprehensive Review

Bücke¹,

Cohen²,

Horvath³

et al. 2022

Rev. Cardiovasc. Med.

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In 2015, mechanical thrombectomy (MT) in combination with intravenous thrombolysis was demonstrated to be superior to best medical treatment alone in patients with anterior circulation stroke. This finding resulted in an unprecedented boost in endovascular stroke therapy, and MT became widely available. MT was initially approved for patients presenting with large vessel occlusion in the anterior circulation (intracranial internal carotid artery or proximal middle cerebral artery) within a 6-hour time window. Eventually, it was shown to be beneficial in a broader group of patients, including those without known symptom-onset, wake-up stroke, or patients with posterior circulation stroke. Technical developments and the implementation of novel thrombectomy devices further facilitated endovascular recanalization for acute ischemic stroke. However, some aspects remain controversial. Is MT suitable for medium or very distal vessel occlusions? Should emergency stenting be performed for symptomatic stenosis or recurrent occlusion? How should patients with large vessel occlusion without disabling symptoms be treated? Do certain patients benefit from MT without intravenous thrombolysis? In the era of personalized decision-making, some of these questions require an individualized approach based on comorbidities, imaging criteria, and the severity or duration of symptoms. Despite its successful development in the past decade, endovascular stroke therapy will remain a challenging and fascinating field in the years to come. This review aims to provide an overview of patient selection, and the indications for and execution of MT in patients with acute ischemic stroke.

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“…Acute ischemic stroke (AIS) is one of the leading causes of mortality in the world and is associated with a high rate of morbidity (1). Despite initial poor outcomes for stent retriever thrombectomy (SRT) in three early trials in 2013 (2)(3)(4), five key randomized controlled studies in 2015 (5)(6)(7)(8)(9) demonstrated good outcomes for SRT relative to controls.…”

Section: Introductionmentioning

confidence: 99%

Frictional force analysis of stent retriever devices using a realistic vascular model: Pilot study

et al. 2022

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ObjectiveTo date, no vascular model to analyze frictional forces between stent retriever devices and vessel walls has been designed to be similar to the real human vasculature. We developed a novel in vitro intracranial cerebrovascular model and analyzed frictional forces of three stent retriever devices.MethodsA vascular mold was created based on digital subtraction angiography of a patient's cerebral vessels. The vascular model was constructed using polydimethylsiloxane (PDMS, Dow Corning, Inc.) as a silicone elastomer. The vascular model was coated on its inner surface with a lubricating layer to create a low coefficient of friction (~0.037) to closely approximate the intima. A pulsatile blood pump was used to produce blood flow inside the model to approximate real vascular conditions. The frictional forces of Trevo XP, Solitaire 2, and Eric 4 were analyzed for initial and maximal friction retrieval forces using this vascular model. The total pulling energy generated during the 3 cm movement was also obtained.ResultsResults for initial retrieval force were as follows: Trevo, 0.09 ± 0.04 N; Solitaire, 0.25 ± 0.07 N; and Eric, 0.33 ± 0.21 N. Results for maximal retrieval force were as follows: Trevo, 0.36 ± 0.07 N; Solitaire, 0.54 ± 0.06 N; and Eric, 0.80 ± 0.13 N. Total pulling energy (N·cm) was 0.40 ± 0.10 in Trevo, 0.65 ± 0.10 in Solitaire, and 0.87 ± 0.14 in Eric, respectively.ConclusionsUsing a realistic vascular model, different stent retriever devices were shown to have statistically different frictional forces. Future studies using a realistic vascular model are warranted to assess SRT devices.

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Should the direct aspiration first pass technique be advocated over the stent-retriever technique for acute ischemic stroke? A systematic review and meta-analysis of 7692 patients

Cited by 6 publications

References 45 publications

Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: evaluating the overlapping meta-analyses

Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: evaluating the overlapping meta-analyses

What You Always Wanted to Know about Endovascular Therapy in Acute Ischemic Stroke but Never Dared to Ask: A Comprehensive Review

Frictional force analysis of stent retriever devices using a realistic vascular model: Pilot study

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