The Use and Utility of Aspiration Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2017 Jul 29

PMID 28751516

Citations 5

Authors

D Wei

J R Mascitelli

D A Nistal

C P Kellner

J T Fifi

J D Mocco

R A de Leacy

Affiliations

Soon will be listed here.

Abstract

Background: Thrombectomy trials are often specifically interpreted as evidence for the effectiveness of stent retrievers. The effectiveness of other thrombectomy techniques such as aspiration thrombectomy should be validated through further investigation and review.

Purpose: To evaluate published treatment times and clinical outcomes in patients treated with aspiration thrombectomy or ADAPT (A Direct Aspiration, First Pass Technique) for acute ischemic stroke.

Data Sources: A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Scopus, and the Cochrane trial register were searched on November 8, 2016.

Study Selection: Twenty studies ( = 1523 patients) were included in this review and meta-analysis. One of these studies was prospective, and the rest were retrospective.

Data Analysis: Meta-analysis was performed by using a random effects model. Data and publication bias were visualized with forest plots and funnel plots.

Data Synthesis: Five studies investigated aspiration thrombectomy only, and 16 studies investigated ADAPT. Of the 16 studies on ADAPT, the rate of successful recanalization (TICI 2b/3) was 89.3% (95% CI, 85.4%-92.3%). The proportion of patients with good clinical outcome (90-day mRS ≤2) was 52.7% (95% CI, 48.0%-57.4%).

Limitations: Studies on ADAPT were retrospective, and there was heterogeneity between studies for successful recanalization ( < .001) and good clinical outcome ( < .001). There was evidence of publication bias for recanalization rates ( = .01), but not for clinical outcomes ( = .42).

Conclusions: ADAPT and aspiration thrombectomy are effective approaches to thrombectomy, with high recanalization rates and excellent clinical outcomes reported in the literature. Aspiration thrombectomy is a promising neurointervention, but large prospective randomized studies are needed to validate its utility.

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References

Saver J, Goyal M, Bonafe A, Diener H, Levy E, Pereira V . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372(24):2285-95. DOI: 10.1056/NEJMoa1415061. View

Turk A, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A . ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg. 2014; 6(4):260-4. DOI: 10.1136/neurintsurg-2014-011125. View

Eom Y, Hwang Y, Hong J, Choi J, Lim Y, Kang D . Forced arterial suction thrombectomy with the penumbra reperfusion catheter in acute basilar artery occlusion: a retrospective comparison study in 2 Korean university hospitals. AJNR Am J Neuroradiol. 2014; 35(12):2354-9. PMC: 7965314. DOI: 10.3174/ajnr.A4045. View

Campbell B, Mitchell P, Kleinig T, Dewey H, Churilov L, Yassi N . Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015; 372(11):1009-18. DOI: 10.1056/NEJMoa1414792. View

Delgado Almandoz J, Kayan Y, Young M, Fease J, Scholz J, Milner A . Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg. 2015; 8(11):1123-1128. DOI: 10.1136/neurintsurg-2015-012122. View

Kowoll A, Weber A, Mpotsaris A, Behme D, Weber W . Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg. 2015; 8(3):230-4. DOI: 10.1136/neurintsurg-2014-011520. View

Bracard S, Ducrocq X, Mas J, Soudant M, Oppenheim C, Moulin T . Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016; 15(11):1138-47. DOI: 10.1016/S1474-4422(16)30177-6. View

Kang D, Kim Y, Hwang Y, Park J, Hwang J, Kim Y . Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation. Stroke. 2013; 44(12):3577-9. DOI: 10.1161/STROKEAHA.113.002673. View

Turk 3rd A, Campbell J, Spiotta A, Vargas J, Turner R, Chaudry M . An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke. J Neurointerv Surg. 2013; 6(1):77-80. DOI: 10.1136/neurintsurg-2012-010616. View

10.

Lapergue B, Blanc R, Guedin P, Decroix J, Labreuche J, Preda C . A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study. AJNR Am J Neuroradiol. 2016; 37(10):1860-1865. PMC: 7960455. DOI: 10.3174/ajnr.A4840. View

11.

Kim S, Yoon W, Moon S, Park M, Jeong G, Kang H . Outcomes of manual aspiration thrombectomy for acute ischemic stroke refractory to stent-based thrombectomy. J Neurointerv Surg. 2014; 7(7):473-7. DOI: 10.1136/neurintsurg-2014-011203. View

12.

Goyal M, Menon B, van Zwam W, Dippel D, Mitchell P, Demchuk A . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387(10029):1723-31. DOI: 10.1016/S0140-6736(16)00163-X. View

13.

Park J, Kwak H . Manual Aspiration Thrombectomy Using Penumbra Catheter in Patients with Acute M2 Occlusion : A Single-Center Analysis. J Korean Neurosurg Soc. 2016; 59(4):352-6. PMC: 4954882. DOI: 10.3340/jkns.2016.59.4.352. View

14.

Kim Y, Son S, Kang D, Hwang Y, Kim Y . Endovascular thrombectomy for M2 occlusions: comparison between forced arterial suction thrombectomy and stent retriever thrombectomy. J Neurointerv Surg. 2016; 9(7):626-630. DOI: 10.1136/neurintsurg-2016-012466. View

15.

Kabbasch C, Mohlenbruch M, Stampfl S, Mpotsaris A, Behme D, Liebig T . First-line lesional aspiration in acute stroke thrombectomy using a novel intermediate catheter: Initial experiences with the SOFIA. Interv Neuroradiol. 2016; 22(3):333-9. PMC: 4984371. DOI: 10.1177/1591019916632370. View

16.

Mascitelli J, Kellner C, Oravec C, De Leacy R, Oermann E, Yaeger K . Factors associated with successful revascularization using the aspiration component of ADAPT in the treatment of acute ischemic stroke. J Neurointerv Surg. 2016; 9(7):636-640. DOI: 10.1136/neurintsurg-2016-012439. View

17.

Mocco J, Zaidat O, von Kummer R, Yoo A, Gupta R, Lopes D . Aspiration Thrombectomy After Intravenous Alteplase Versus Intravenous Alteplase Alone. Stroke. 2016; 47(9):2331-8. DOI: 10.1161/STROKEAHA.116.013372. View

18.

Vargas J, Spiotta A, Fargen K, Turner R, Chaudry I, Turk A . Long term experience using the ADAPT technique for the treatment of acute ischemic stroke. J Neurointerv Surg. 2016; 9(5):437-441. DOI: 10.1136/neurintsurg-2015-012211. View

19.

Romano D, Cioni S, Vinci S, Pero G, Comelli C, Comai A . Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centers. J Neurointerv Surg. 2016; 9(1):6-10. DOI: 10.1136/neurintsurg-2016-012298. View

20.

Kim Y, Kwak H, Chung G, Hwang S . Manual aspiration thrombectomy using the Penumbra catheter in patients with acute M1 occlusion: A single-center study. Interv Neuroradiol. 2015; 21(6):694-9. PMC: 4757361. DOI: 10.1177/1591019915609167. View