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Ischemic stroke
Original research
First-line contact aspiration versus first-line stent retriever for acute posterior circulation strokes: an updated meta-analysis
  1. Gengfan Ye1,
  2. Xuebin Wen2,
  3. Hongcai Wang1,
  4. Chengfeng Sun1,
  5. Zhihao Pan2,
  6. Maosong Chen1,
  7. Boding Wang1,
  8. Zhenqiang Li1
  1. 1 Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
  2. 2 Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
  1. Correspondence to Dr Zhenqiang Li; sky13968{at}163.com; Dr Boding Wang; nbwbd{at}sina.com

Abstract

Background Both stent retriever (SR) and contact aspiration (CA) are widely used as first-line strategies for acute posterior circulation strokes (PCS). However, it is still unclear how CA and SR compare as the first-line treatment of acute PCS. Several new studies have been published recently, so we aimed to perform an updated meta-analysis.

Methods The meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Random-effects models were performed to pool the outcomes and the value of I2 was calculated to assess the heterogeneity.

Results Ten observational studies with 1189 patients were included, among whom 492 received first-line CA and 697 received first-line SR. The pooled results revealed that first-line CA could achieve a significantly higher proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3 (OR 1.90, 95% CI 1.33 to 2.71, I2=0%), mTICI 3 (OR 1.95, 95% CI 1.15 to 3.31, I2=59.6%), first-pass effect (OR 2.91, 95% CI 1.51 to 5.58, I2=0%), lower incidence of new-territory embolic events (OR 0.20, 95% CI 0.05 to 0.83, I2=0%), and shorter procedure time (mean difference −29.4 min, 95% CI −46.8 to −12.0 min, I2=62.8%) compared with first-line SR. At 90-day follow-up, patients subjected to first-line CA showed a higher functional independence (modified Rankin Scale score 0–2; OR 1.38, 95% CI 1.01 to 1.87, I2=23.5%) and a lower mortality (OR 0.71, 95% CI 0.50 to 1.00, p=0.050, I2=0%) than those subjected to first-line SR.

Conclusions This meta-analysis suggests that the first-line CA strategy could achieve better recanalization and clinical outcomes for acute PCS than first-line SR. Limited by the quality of included studies, this conclusion should be drawn with caution.

  • stroke
  • thrombectomy
  • technique

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data are available in the manuscript.

https://doi.org/10.1136/neurintsurg-2021-017497

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All data are available in the manuscript.

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    Footnotes

    • GY and XW are joint first authors.

    • BW and ZL contributed equally.

    • GY and XW contributed equally.

    • Contributors Study design: GFY, XBW, BDW, ZQL. Literature search and selection: GFY, XBW, CFS, ZHP. Data extraction: GFY, XBW, HCW. Data analysis: GFY, XBW, HCW. Interpretation: all authors. Initial draft of manuscript: GFY, WBW, HCW. Reviewing and editing: CFS, ZHP, MSC, BDW, ZQL. Supervision: MSC, BDW, ZQL.

    • Funding This work was supported by the Ningbo Medical Science and Technology Project with grant number (2020Y02).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.