From the Division of Neurosurgery (C.O.A.T.), Department of Surgery
Department of Medical Imaging (C.O.A.T., W.B., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada.
AJNR Am J Neuroradiol. 2018 Nov;39(11):2070-2076. doi: 10.3174/ajnr.A5825. Epub 2018 Oct 18.
There is ongoing debate regarding the optimal first-line thrombectomy technique for large-vessel occlusion.
We performed a systematic review and meta-analysis of comparative studies on stent retriever-first and aspiration-first thrombectomy.
We searched Ovid MEDLINE, PubMed, and EMBASE from 2009 to February 2018.
Two reviewers independently selected the studies. The primary end point was successful reperfusion (TICI 2b/3).
Random-effects meta-analysis was used for analysis.
Eighteen studies including 2893 patients were included. There was no significant difference in the rate of final successful reperfusion (83.9% versus 83.3%; OR = 0.87; 95% CI, 0.62%-1.27%) or good functional outcome (mRS 0-2) at 90 days (OR = 1.07; 95% CI, 0.80-1.44) between the stent-retriever thrombectomy and aspiration groups. The stent-retriever thrombectomy-first group achieved a statistically significant higher TICI 2b/3 rate after the first-line device than the aspiration-first group (74.9% versus 66.4%; OR = 1.53; 95% CI, 1.14%-2.05%) and resulted in lower use of a rescue device (19.9% versus 32.5%; OR = 0.36; 95% CI, 0.14%-0.90%). The aspiration-first approach resulted in a statistically shorter groin-to-reperfusion time (weighted mean difference, 7.15 minutes; 95% CI, 1.63-12.67 minutes). There was no difference in the number of passes, symptomatic intracerebral hemorrhage, vessel dissection or perforation, and mortality between groups.
Most of the included studies were nonrandomized. There was significant heterogeneity in some of the outcome variables.
Stent-retriever thrombectomy-first and aspiration-first thrombectomy were associated with comparable final reperfusion rates and functional outcome. Stent-retriever thrombectomy was superior in achieving reperfusion as a stand-alone first-line technique, with lower use of rescue devices but a longer groin-to-reperfusion time.
对于大血管闭塞，关于首选机械取栓技术仍存在争议。
我们对支架取栓优先和抽吸优先取栓的比较研究进行了系统评价和荟萃分析。
我们从 2009 年至 2018 年 2 月在 Ovid MEDLINE、PubMed 和 EMBASE 进行了检索。
两位审查员独立选择研究。主要终点为再通成功（TICI 2b/3）。
采用随机效应荟萃分析进行分析。
纳入 18 项研究共 2893 例患者。支架取栓组和抽吸组的最终再通率（83.9%比 83.3%；OR=0.87；95%CI，0.62%1.27%）和 90 天良好功能结局（mRS 02）差异无统计学意义（OR=1.07；95%CI，0.801.44）。支架取栓优先组在首次使用设备后达到 TICI 2b/3 率显著高于抽吸优先组（74.9%比 66.4%；OR=1.53；95%CI，1.14%2.05%），且需要使用挽救性设备的比例更低（19.9%比 32.5%；OR=0.36；95%CI，0.14%0.90%）。抽吸优先组的股动脉至再通时间更短（加权均数差，7.15 分钟；95%CI，1.6312.67 分钟）。两组之间的通过次数、症状性颅内出血、血管夹层或穿孔以及死亡率差异无统计学意义。
纳入的大多数研究是非随机的。一些结局变量存在显著的异质性。
支架取栓优先和抽吸优先取栓的最终再通率和功能结局相当。支架取栓作为单一的一线技术，其再通效果更优，挽救性设备使用率更低，但股动脉至再通时间更长。
