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. 2023 Jun;15(6):539-546.
doi: 10.1136/jnis-2022-019344. Epub 2022 Oct 12.

First-line thrombectomy strategy for distal and medium vessel occlusions: a systematic review

Cem Bilgin #  1 , Nicole Hardy #  2 , Kristen Hutchison  2 , John Michael Pederson  2   3 , Alexander Mebane  3 , Peace Olaniran  2 , Hassan Kobeissi  4 , Kevin M Kallmes  2 , David Fiorella  5 , David F Kallmes  6 , Waleed Brinjikji  6
Affiliations

First-line thrombectomy strategy for distal and medium vessel occlusions: a systematic review

Cem Bilgin et al. J Neurointerv Surg. 2023 Jun.

Abstract

Background: The benefit of mechanical thrombectomy (MT) and efficacy of different first-line MT techniques remain unclear for distal and medium vessel occlusions (DMVOs). In this systematic review, we aimed to compare the performance of three first-line MT techniques in DMVOs.

Methods: The PubMed database was searched for studies examining the utility of MT in DMVOs (middle cerebral artery M2-3-4, anterior cerebral artery, and posterior cerebral artery). Studies providing data for aspiration thrombectomy (ASP), stent retriever thrombectomy (SR), and combined SR+ASP technique were included. Non-comparative studies were excluded. Safety and efficacy data were collected for each technique. The Nested Knowledge AutoLit platform was utilized for literature search, screening, and data extraction. Pooled data were presented as descriptive statistics.

Results: 13 studies comprising 2422 MT procedures were identified. The overall successful recanalization rate was 77.0% (1513/1964) for DMVOs. SR+ASP had a successful recanalization rate of 83.7% (297/355), SR had a 75.6% rate (638/844), while ASP alone had a 74.2% rate (386/520). The overall functional independence rate was 51.3% (851/1659) among DMVOs. The ASP alone group had a functional independence rate of 46.9% (219/467), while functional independence rates of the SR and SR+ASP groups were 51.5% (372/723) and 61.7% (174/282), respectively. Finally, the subarachnoid hemorrhage rates were 1.8% (4/217) for the ASP group, 9.3% (26/281) for the SR group, and 11.9% (41/344) for the SR+ASP group.

Conclusions: Our systematic review supports the proposition that MT is a safe and effective treatment option for DMVOs. Additionally, while the SR+ASP group had consistently high rates of clot clearance and good neurological outcomes, the SR and SR+ASP groups also had higher rates of subarachnoid hemorrhage, highlighting the need for improved DMVO treatment devices.

Keywords: stroke; thrombectomy.

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Conflict of interest statement

Competing interests: NH works for and holds equity in Nested Knowledge; KH works for Nested Knowledge and Superior Medical Experts; JMP is employed by and has ownership interest in Superior Medical Experts and Nested Knowledge; AM works for Superior Medical Experts; KMK works for and holds equity in Nested Knowledge and holds equity in Superior Medical Experts; DF consults for Medtronic, Cerenovus, Microvention, Stryker, Balt, RAPID.AI, RAPID Medical, Qapel Medical, Arsenal Medical, Phenox Medical, Perfuze, hold equity in MENTICE, Neurogami, Marblehead, Scientia Medical, NVMed, received research support from Microvention, Penumbra, Stryker, Balt, and Siemens; DFK consults for Medtronic, has ownership interest in Superior Medical Experts, Nested Knowledge Marblehead Medical, Conway Medical, Monarch Biosciences, Piraeus Medical, received research support from Cerenovus, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, and MIVI Neuroscience; WB consults for Medtronic, has ownership interest in Superior Medical Experts, and received research support from MIVI Neuroscience.

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