Firstline a direct aspiration first pass technique versus firstline stent retriever for acute basilar artery occlusion: a systematic review and meta-analysis

Abstract

IntroductionAcute basilar artery occlusion (BAO) can result in extremely high disability and mortality. Stent retrievers (SRs) can achieve a high recanalization rate for BAO, therefore improving favorable outcomes. However, the efficacy of a direct aspiration first pass technique (ADAPT) to treat BAO is unclear. Our aim was to compare the efficacy and safety of firstline ADAPT with that of firstline SR for patients with acute BAO.MethodsThree databases were systematically searched for literature reporting outcomes on thrombectomy for acute BAO with both firstline ADAPT and firstline SR. The modified Newcastle–Ottawa scale was applied to assess bias risk. The random effects model was used.ResultsOf 50 articles, 5 cohort studies (2 prospective and 3 retrospective) were included in our research. 193 cases were treated with firstline ADAPT and 283 cases received firstline SR. Successful recanalization rate was significantly higher in the firstline ADAPT group (OR=2.0, 95% CI 1.1 to 3.5). Procedure time (mean difference=−27.6 min, 95% CI −51.0 to −4.3) and the incidence of new territory embolic event (OR=0.2, 95% CI 0.05 to 0.83) was significantly less in the firstline ADAPT group. No significant difference was observed between the firstline ADAPT and firstline SR groups for rate of complete recanalization, rescue therapy, any hemorrhagic complication, favorable outcomes, or mortality at 90 days.ConclusionsOur meta-analysis suggested that for patients with acute BAO, firstline ADAPT might achieve higher and faster recanalization, comparable neurological improvement and safety compared with firstline SR. Further studies are needed to confirm these results.

Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

“…For the subgroup of posterior circulation strokes comparative analysis of different stroke techniques remain scarce. In our study, the final successful reperfusion rate (mTICI ≥2b) of 89% with SAVE is higher to those of previous stent retriever series of 81% and 83% published in two meta-analysis of Gory et al and Ye et al, respectively, [22,23] and the ENDOSTROKE registry, which reported a TICI 2b/3 rate of 79% [7]. Previous studies, which were not included in the meta-analyses showed successful reperfusion in 70% and 73% of cases, respectively [24,25].…”

Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

“…For the subgroup of posterior circulation strokes comparative analysis of different stroke techniques remain scarce. In our study, the final successful reperfusion rate (mTICI ≥2b) of 89% with SAVE is comparable to those of previous stent retriever series of 81% and 83% published in two meta-analysis of Gory et al and Ye et al, respectively, [22,23] and the ENDOSTROKE registry, which reported a TICI 2b/3 rate of 79% [7]. Previous studies, which were not included in the meta-analyses showed successful reperfusion in 70% and 73% of cases, respectively [24,25].…”

“…A recent study in fact demonstrated aspiration only as the better first-line strategy for BAO patients compared to stent retriever for complete reperfusion with rates of 54% and 32%, respectively [6], and were comparable to 67% mTICI 3 results with SAVE in our study. However, another study did not show differences between aspiration only and stent retrieving with regard to complete reperfusion [23]. Unfortunately, a comparison of the first-pass results is not possible due to lack of such information in the aforementioned studies; however, first-pass reperfusion results with SAVE were promising with 56-67% (mTICI ≥2b/≥2c/3) and significantly higher compared to aspiration only, which led to a significant lower number of thrombectomy attempts with SAVE.…”

Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

“…For the subgroup of posterior circulation strokes comparative analysis of different stroke techniques remain scarce. In our study, the final successful reperfusion rate (mTICI ≥2b) of 89% with SAVE is higher to those of previous stent retriever series of 81% and 83% published in two meta-analysis of Gory et al and Ye et al, respectively, [18,19] and the ENDOSTROKE registry, which reported a TICI 2b/3 rate of 79% [7]. A recent study in fact demonstrated aspiration only as the better first-line strategy for BAO patients compared to stent retriever for complete reperfusion with rates of 54% and 32%, respectively [6], but were lower to 67% final mTICI 3 results with SAVE in our study.…”

“…A recent study in fact demonstrated aspiration only as the better first-line strategy for BAO patients compared to stent retriever for complete reperfusion with rates of 54% and 32%, respectively [6], but were lower to 67% final mTICI 3 results with SAVE in our study. However, another study did not show differences between aspiration only and stent retrieving with regard to complete reperfusion [19]. Unfortunately, a comparison of the first-pass results is not possible due to lack of such information in the aforementioned studies; however, first-pass reperfusion results with SAVE were promising with 56 -67% (mTICI ≥2b/≥2c/3) and significantly higher compared to aspiration only, which led to a significant lower number of thrombectomy attempts with SAVE.…”