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  • Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke: systematic review and meta-analysis

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Ischemic stroke
Mechanical thrombectomy for the treatment of primary and secondary distal medium-vessel occlusion stroke: systematic review and meta-analysis
  1. Aaron Rodriguez-Calienes1,2,
  2. Juan Vivanco-Suarez1,
  3. Joel M Sequeiros3,
  4. Milagros Galecio-Castillo1,
  5. Cynthia B Zevallos1,
  6. Mudassir Farooqui1,
  7. Santiago Ortega-Gutierrez4
  1. 1 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
  3. 3 Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  4. 4 Department of Neuroloy, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Santiago Ortega-Gutierrez, Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; santy-ortega{at}uiowa.edu

Abstract

Background There is limited evidence on the indication and role of mechanical thrombectomy (MT) in patients with distal medium-vessel occlusions (DMVOs). The aim of this systematic review and meta-analysis was to evaluate all the evidence available on the efficacy and safety of MT techniques (stent retriever, aspiration) in primary and secondary DMVOs.

Methods Five databases were searched from inception to January 2023 for studies of MT in primary and secondary DMVOs. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0–2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Prespecified subgroup meta-analyses according to the specific MT technique and to the vascular territory (distal M2-M5, A2-A5, P2-P5) were also performed.

Results A total of 29 studies with 1262 patients were included. For primary DMVOs (n=971 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 84% (95% confidence interval (CI) 76 to 90%), 64% (95% CI 54 to 72%), 12% (95% CI 8 to 18%), and 6% (95% CI 4 to 10%), respectively. For secondary DMVOs (n=291 patients), pooled rates of successful reperfusion, favorable outcome, 90-day mortality and sICH were 82% (95% CI 73 to 88%), 54% (95% CI 39 to 69%), 11% (95% CI 5 to 20%), and 3% (95% CI 1 to 9%), respectively. Subgroup analyses by MT technique and by vascular territory showed no differences in primary and secondary DMVOs.

Conclusion Our findings suggest that MT using aspiration or stent retriever techniques appears to be effective and safe in primary and secondary DMVOs. However, given the level of evidence of our results, further confirmation in well-designed randomized controlled trials is needed.

  • Stroke
  • Thrombectomy
  • Intervention
  • Brain

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2022-019975

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @AaronCalienes, @jsvivanco1, @joelsequeiros, @mili_galecio, @CerebrovascLab

    • Contributors All authors contributed to the study design and drafting of the manuscript. The search was completed by ARC, JVS, and MGC; screening of articles by ARC, JVS, and MGC; data extraction by ARC, JVS, and MGC; quality control by ARC and JVS; statistical analysis by MGC and ARC; interpretation of data by ARC, JMS, MF, and SOG; critical revision by SOG. SOG is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SOG has grants from NIH-NINDS, Stryker, Medtronic, Microvention, Methinks, IschemiaView, Viz.ai, Siemens, and consulting fees for Medtronic and Stryker.

    • 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.