Article Text
Abstract
Background The choice of angiography system could influence the outcomes of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS), but its impact is not yet well understood. This study aims to compare the clinical and technical outcomes of MT performed with single plane versus biplane angiography systems.
Method We conducted a systematic review and meta-analysis, following PRISMA guidelines, by searching PubMed, Embase, Web of Science, and Scopus to include studies on patients with AIS who underwent MT with either single plane or biplane angiography up to May 4, 2024. The primary outcome was a favorable outcome defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days after the procedure. Data were analyzed using a random-effects model and heterogeneity was assessed using the I2 test and Q statistics.
Results Five studies with a total of 1562 patients were analyzed. Of these, 68.4% were treated with biplane systems and 31.6% with single plane systems. Single plane angiography was associated with a significantly higher rate of favorable outcomes (OR 1.43; 95% CI 1.13 to 1.80; P<0.01). There were no significant differences in successful recanalization, periprocedural complications, procedure time, total fluoroscopy time, or contrast volume between the two systems.
Conclusion While single plane angiography systems may offer slightly better outcomes in MT for AIS, both systems appear equally effective in most clinical and technical perspectives, suggesting that system selection may be more dependent on availability and procedural requirements rather than inherent superiority. Our findings may encourage clinicians to use single-plane angiography in settings where the biplane angiography suite availability is limited, but it should be noted that this observation may have been influenced by selection bias, particularly since the larger studies included in our meta-analysis did not observe this effect in adjusted analyses for potential confounder factors.
- Angiography
- Intervention
- Stroke
- Thrombectomy
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
X @cembilgincb, @yigitcs
Contributors AO designed the concept, collected the data, analyzed and interpreted the data, and drafted the manuscript and he is also guarantor in this study. CB contributed to the screening process, study selection and data extraction, and reviewed the submitted version of the manuscript. JC contributed to administrative, technical, and material support, and reviewed the submitted version of the manuscript. JJC contributed to the screening process, data extraction and reviewed the submitted version of the manuscript. SZ contributed to technical support and reviewed the submitted version of the manuscript. YCS contributed to creating the table and reviewed the submitted version of the manuscript. BM contributed to technical support and reviewed the submitted version of the manuscript. SG edited the language of the submitted version of the manuscript. EAB reviewed the submitted version of the manuscript. ZB reviewed the submitted version of the manuscript. WB interpreted the data, critically revised the paper, and reviewed the submitted version of the manuscript. DFK designed the concept, interpreted the data, critically revised the paper, supervised, and reviewed the submitted version of the manuscript. All authors read and approved the final manuscript.
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 JC receives educational grants from Medtronic, Phenox, Balt, French Society of Radiology (Bourse de Recherche Alain Rahmouni SFR-CERF), Philippe Foundation, French Society of Neuroradiology (Bourse de Mobilité Anne Bertrand SFNR). WB holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology. He receives consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. DFK holds equity in Nested Knowledge, Superior Medical Experts, Marblehead Medical, Conway Medical, Monarch Biosciences, and Piraeus Medical. He has patents for balloon guide technology and spine augmentation. He receives grants or research support from Cerenovus, Insera Therapeutics, Medtronic, MicroVention, Balt, Monarch Biosciences, Brainomix, MiVi and Stryker and has served on the Data Safety Monitoring Board for NoNO Inc and Vesalio. He has receipts for software use from Brainomix and received royalties from Medtronic.
Provenance and peer review Not commissioned; externally peer reviewed.