AUTHOR=Loh Enver De Wei , Kwok Gabriel Yi Ren , Toh Keith Zhi Xian , Koh Ming Yi , Teo Yao Hao , Teo Yao Neng , Chan Bernard P. L. , Sharma Vijay Kumar , Ng Megan Bi-Jia , Lim Hui Shi , Soon Betsy , Gopinathan Anil , Yang Cunli , Sia Ching-Hui , Bhogal Pervinder , Brouwer Patrick A. , Meyer Lukas , Fiehler Jens , Andersson Tommy , Tan Benjamin Y. Q. , Yeo Leonard L. L. 

TITLE=Thrombectomy for distal medium vessel occlusion stroke: Combined vs. single-device techniques - A systematic review and meta-analysis

JOURNAL=Frontiers in Stroke

VOLUME=Volume 2 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/stroke/articles/10.3389/fstro.2023.1126130

DOI=10.3389/fstro.2023.1126130

ISSN=2813-3056

ABSTRACT=Background
The optimal mechanical thrombectomy technique for acute ischaemic stroke (AIS) caused by distal, medium vessel occlusion (DMVO) is uncertain. We performed a systematic review and meta-analysis evaluating the efficacy and safety of first-line thrombectomy with combined techniques, which entail simultaneous use of a stent retriever and aspiration catheter, versus single-device techniques, whether stent retriever or direct aspiration alone, for DMVO-AIS patients.
Methods
We systematically searched the PubMed, Embase and Cochrane CENTRAL databases from inception until 2 September 2022 for studies comparing combined and single-device techniques in DMVO-AIS patients. We adopted the Distal Thrombectomy Summit Group’s definition of DMVO. Our outcomes were the modified first-pass effect (mFPE; modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3 at first-pass), first-pass effect (FPE; mTICI 2c-3 at first-pass), successful and complete final reperfusion (mTICI 2b-3 and 2c-3 at end of all procedures, respectively), 90-day functional independence (modified Rankin scale 0-2), 90-day mortality, and symptomatic intracranial haemorrhage (sICH).
Results
Nine studies were included, with 477 patients receiving combined techniques, and 670 patients receiving single-device thrombectomy. Combined techniques achieved significantly higher odds of mFPE (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.12-4.02; p=0.021) and FPE (OR, 3.55; 95% CI, 1.97-6.38; p<0.001), with lower odds of sICH (OR, 0.23; 95% CI, 0.06-0.93; p=0.040). There were no significant differences in final reperfusion, functional independence (OR, 1.19; 95% CI 0.87-1.63; p=0.658), or mortality (OR, 0.94; 95% CI, 0.50-1.76; p=0.850).
Conclusions
In DMVO-AIS patients, mechanical thrombectomy combining stent retrievers and aspiration catheters achieved higher odds of FPE and lower odds of sICH over single-device techniques. There were no differences in functional independence and mortality. Further trials are warranted to establish these findings.