A Meta-analysis of Combined Aspiration Catheter and Stent Retriever versus Stent Retriever Alone for Large-Vessel Occlusion Ischemic Stroke

Abstract

BACKGROUND: The efficacy of combined aspiration catheter and stent retriever compared with stent retriever alone for the treatment of large-vessel occlusion acute ischemic stroke is unclear. PURPOSE: Our aim was to conduct a systematic literature review and meta-analysis on several metrics of efficacy comparing aspiration catheter and stent retriever with stent retriever alone. DATA SOURCES: MEDLINE and the Cochrane Library Databases were searched. Randomized controlled trials and case-control and cohort studies were included. STUDY SELECTION: Ten comparative studies were included detailing a combined 1495 patients with aspiration catheter and stent retriever and 1864 with stent retrievers alone. DATA ANALYSIS: Data on first pass effect (TICI 2b/2c/3 after first pass), final successful reperfusion (modified TICI $2b), and 90-day functional independence (mRS # 2) were collected. Meta-analysis was performed using a random-effects model. DATA SYNTHESIS: There was a pooled composite first pass effect of 40.8% (611/1495) versus 32.6% (608/1864) for aspiration catheter and stent retriever and stent retriever alone, respectively (P, .0001). Similarly, on a meta-analysis, aspiration catheter and stent retriever were associated with a higher first pass effect compared with stent retriever alone (OR ¼ 1.63; 95% CI, 1.20–2.21; P ¼ .002; I2 ¼ 72%). There was no significant difference in composite rates of successful reperfusion between aspiration catheter and stent retriever (72.8%, 867/1190) and stent retriever alone (70.8%, 931/1314) (P ¼ .27) or on meta-analysis (OR ¼ 1.31; CI, 0.81–2.12; P ¼ .27; I2 ¼ 82%). No difference was found between aspiration catheter and stent retriever and stent retriever alone on 90-day functional independence (OR ¼ 1.02; 95% CI, 0.77–1.36; P ¼ .88; I2 ¼ 40%). LIMITATIONS: This study is limited by high interstudy heterogeneity. CONCLUSIONS: On meta-analysis, aspiration catheter and stent retriever are associated with a superior first pass effect compared with stent retriever alone, but they are not associated with statistically different final reperfusion or functional independence.