Marion Boulanger1, Bertrand Lapergue2, Francis Turjman3, Emmanuel Touzé1, René Anxionnat4,5, Serge Bracard4,5, Michel Piotin6, Benjamin Gory4,5. 1. 1 Normandie University, UNICAEN, Inserm U1237, CHU Caen, Stroke Unit, Caen, France. 2. 2 Department of Neurology, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France. 3. 3 Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France. 4. 4 Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France. 5. 5 University of Lorraine, INSERM U1254, IADI, F-54000, Nancy, France. 6. 6 Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France.
Abstract
BACKGROUND: In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. PURPOSE: The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion. METHODS: We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. We determined rates of final complete reperfusion (defined as modified Thrombolysis In Cerebral Infarction score = 3), periprocedural complications and 90-day functional independence (defined as modified Rankin Scale (mRS) score 0-2), and excellent outcome (defined as mRS score 0-1) after contact aspiration and after stent-retriever thrombectomy using random-effects meta-analyses. Any differential effects in rates between the two strategies were assessed using random-effects meta-regressions. RESULTS: Fifteen studies (1817 patients) were included. There was no difference in rates of final complete reperfusion at the end of all endovascular procedures between contact aspiration and stent retrievers (51.1%, 95% confidence interval (CI) 39.3-62.9; vs 38.3%, 95% CI 28.6-48.0; pint = 0.14), 90-day functional independence (45.0%, 40.7-49.2; vs 52.4%, 47.7-57.1; pint = 0.45) and excellent outcome (32.1%, 25.7-38.5; vs 34.1%, 21.2-46.9; pint = 0.94). Rates of periprocedural complications did not differ between the two strategies. CONCLUSIONS: Current data suggest no difference in efficacy and safety between first-line contact aspiration and stent-retriever thrombectomy in stroke patients with large-artery occlusion.
BACKGROUND: In acute ischemic strokepatients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. PURPOSE: The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in strokepatients with anterior circulation large-artery occlusion. METHODS: We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. We determined rates of final complete reperfusion (defined as modified Thrombolysis In Cerebral Infarction score = 3), periprocedural complications and 90-day functional independence (defined as modified Rankin Scale (mRS) score 0-2), and excellent outcome (defined as mRS score 0-1) after contact aspiration and after stent-retriever thrombectomy using random-effects meta-analyses. Any differential effects in rates between the two strategies were assessed using random-effects meta-regressions. RESULTS: Fifteen studies (1817 patients) were included. There was no difference in rates of final complete reperfusion at the end of all endovascular procedures between contact aspiration and stent retrievers (51.1%, 95% confidence interval (CI) 39.3-62.9; vs 38.3%, 95% CI 28.6-48.0; pint = 0.14), 90-day functional independence (45.0%, 40.7-49.2; vs 52.4%, 47.7-57.1; pint = 0.45) and excellent outcome (32.1%, 25.7-38.5; vs 34.1%, 21.2-46.9; pint = 0.94). Rates of periprocedural complications did not differ between the two strategies. CONCLUSIONS: Current data suggest no difference in efficacy and safety between first-line contact aspiration and stent-retriever thrombectomy in strokepatients with large-artery occlusion.
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