Neurointervention.  2018 Sep;13(2):100-109. 10.5469/neuroint.2018.00997.

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

• Phan K
• Maingard J
• Kok HK
• Dmytriw AA
• Goyal S
• Chandra R
• Brooks DM
• Thijs V
• Asadi H

• KMID: 2424058
• DOI: http://doi.org/10.5469/neuroint.2018.00997

Abstract

PURPOSE
The 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 METHODS
Study 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.
RESULTS
Hypertension 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).
CONCLUSION
Both 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.

Keyword

Cerebrovascular disorders; Ischemia; Stroke; Thrombectomy; Endovascular procedures; Middle cerebral artery

MeSH Terms

Alberta
Cerebral Infarction
Cerebrovascular Disorders
Cohort Studies
Endovascular Procedures
Groin
Humans
Hyperlipidemias
Hypertension
Ischemia
Middle Cerebral Artery*
Punctures
Reperfusion
Stroke*
Thrombectomy*

Figure

• 

  Fig. 1. PRISMA flow chart of search strategy for the present systematic review and meta-analysis. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; MCA, middle cerebral artery; mRS, modified Rankin scale; TICI, thrombolysis in cerebral infarction.

• 

  Fig. 2. Forest plot compares pooled outcomes of stent-retriever versus contact aspiration for TICI 2b–3 (P-value for difference 0.168). CI, confidence interval; Ev, events; Trt, treatment; ASTER, Contact Aspiration Versus Stent Retriever for Successful Revascularization; ADAPT, A Direct Aspiration First Pass Technique; TICI, thrombolysis in cerebral infarction.

• 

  Fig. 3. Forest plot compares pooled outcomes of stent-retriever versus contact aspiration for 90-day mRS 0–2 (P-value for difference 0.041). CI, confidence interval; Ev, events; Trt, treatment; ADAPT, A Direct Aspiration First Pass Technique; mRS, modified Rankin scale.

• 

  Fig. 4. Forest plot compares pooled outcomes of stent-retriever versus contact aspiration for 90-day mortality (P-value for difference 0.212). CI, confidence interval; Ev, events; Trt, treatment; ADAPT, A Direct Aspiration First Pass Technique.

• 

  Fig. 5. Correlation analysis for good clinical outcome mRS 0–2. Open circles represent contact aspiration, closed circles represent stent-retriever thrombectomy. mRS, modified Rankin scale.

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