952 hospital of the Chinese people's liberation army ground force, Neurology department, Geermu, Qinghai Province, 816000, China.
952 hospital of the Chinese people's liberation army ground force, Neurology department, Geermu, Qinghai Province, 816000, China.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105374. doi: 10.1016/j.jstrokecerebrovasdis.2020.105374. Epub 2020 Oct 27.
The aim of this systematic review and meta-analysis was to compare the performance of first-line contact aspiration (ASP) and stent retriever (SR) in acute ischemic stroke caused by proximal large vessel occlusion.
Cochrane databases, MEDLINE and EMBASE were systematically searched for literatures reporting outcomes on thrombectomy with both first-line aspiration and first-line stent retriever in proximal occlusion.
Thirteen studies with a total of 1614 patients were included. No differences were identified between the SR and ASP groups in terms of final reperfusion rate (modified thrombolysis in cerebral infarction 2b/3) (OR: 1.54, 95% CI: 0.88-2.70), complete recanalization rate (modified thrombolysis in cerebral infarction 3) (OR: 1.78, 95% CI: 0.58-5.44), and favorable outcomes (modified Rankin scale ≤2) (OR: 1.02, 95% CI: 0.79-1.32). With regard to adverse events, emboli to new territories (OR: 0.81, 95% CI: 0.31-2.14), intracranial hemorrhage (OR: 0.71, 95% CI: 0.40-1.28), 90-days mortality (OR: 1.02, 95% CI: 0.71-1.47) were similar between groups, while symptomatic intracerebral hemorrhage (OR: 0.43 95% CI: 0.21-0.86) was less seen in ASP. Subgroup analysis indicated that ASP was comparable to stent retriever with local aspiration (SRLA) (OR: 1.25 95% CI: 0.25-6.22) and superior to stent retriever alone (OR: 1.85 95% CI: 1.22-2.81). Moreover, in posterior circulation, contact aspiration achieved a significantly higher reperfusion (OR: 1.97 95% CI: 1.03-3.76) compared to stent retriever, and needed relatively less rescue therapies (21.5% vs 29.6%, p < 0.05).
Our study suggested that contact aspiration might be advantageous over stent retriever alone and more suitable in posterior circulation. While ASP and SRLA thrombectomy were equally effective in achieving good clinical outcomes. However, further studies are needed to confirm these results.
本系统评价和荟萃分析的目的是比较直接接触抽吸（ASP）和支架取栓（SR）在近端大血管闭塞引起的急性缺血性卒中中的表现。
系统地检索了 Cochrane 数据库、MEDLINE 和 EMBASE 中的文献，以报告近端闭塞部位同时行抽吸和支架取栓的血栓切除术的结局。
纳入了 13 项共纳入 1614 例患者的研究。在最终再灌注率（改良脑梗死溶栓 2b/3）（OR：1.54，95%CI：0.88-2.70）、完全再通率（改良脑梗死溶栓 3）（OR：1.78，95%CI：0.58-5.44）和良好结局（改良 Rankin 量表≤2）（OR：1.02，95%CI：0.79-1.32）方面，SR 组和 ASP 组之间没有差异。在不良事件方面，新发病灶栓塞（OR：0.81，95%CI：0.31-2.14）、颅内出血（OR：0.71，95%CI：0.40-1.28）和 90 天死亡率（OR：1.02，95%CI：0.71-1.47）相似，而症状性颅内出血（OR：0.43，95%CI：0.21-0.86）在 ASP 组中较少见。亚组分析表明，ASP 与局部抽吸支架取栓（SRLA）（OR：1.25，95%CI：0.25-6.22）相当，优于单独支架取栓（OR：1.85，95%CI：1.22-2.81）。此外，在后循环中，与支架取栓相比，接触抽吸能更显著地实现再灌注（OR：1.97，95%CI：1.03-3.76），且需要相对较少的挽救性治疗（21.5%比 29.6%，p<0.05）。
我们的研究表明，与单独支架取栓相比，接触抽吸可能具有优势，在后循环中更为适用。虽然 ASP 和 SRLA 血栓切除术在获得良好临床结局方面同样有效，但仍需要进一步研究来证实这些结果。
