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Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: evaluating the overlapping meta-analyses
  1. Ahmed Y Azzam1,
  2. Sherief Ghozy2,
  3. Kevin M Kallmes3,
  4. Gautam Adusumilli4,
  5. Jeremy J Heit5,
  6. Ameer E Hassan6,
  7. Ramanathan Kadirvel2,
  8. David F Kallmes2
  1. 1 October 6 University Faculty of Medicine, 6th of October City, Egypt
  2. 2 Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3 Nested Knowledge, St Paul, Minnesota, USA
  4. 4 Department of Radiology and Neurosurgery, Stanford University, Stanford, California, USA
  5. 5 Radiology, Neuroadiology, and Neurointervention Division, Stanford University, Stanford, California, USA
  6. 6 Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
  1. Correspondence to Dr Sherief Ghozy, Department of Radiology, Mayo Clinic Minnesota, Rochester, MN 55905, USA; ghozy.sherief{at}


Background Previous 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.

Objective To 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.

Methods The 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).

Results Seven 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’.

Conclusions Present 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.

  • Thrombectomy
  • Stroke
  • Stent

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  • AYA and SG are joint first authors.

  • Twitter @JeremyHeitMDPHD

  • AYA and SG contributed equally.

  • Contributors AYA, SG, RK, and DFK: contributed to the conception, design of the work, and revising it critically for important intellectual content. All authors contributed to the acquisition, analysis, interpretation of data, and drafting the work. All authors approved the final version of this manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number R01NS076491.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests KMK works for, and holds equity in, Nested Knowledge, Inc., works for Conway Medical LLC, and holds equity in Superior Medical Experts, Inc. JJH is a consultant for Medtronic and MicroVention and a member of the Medical and Scientific Advisory Board for iSchemaView. DFK has the following conflicts: Ownership in Nested Knowledge, Inc., Superior Medical Experts, Inc., Conway Medical LLC; research support from Microvention, Balt USA, Medtronic.

  • 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.