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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 251-261
DOI: 10.4103/ajns.AJNS_151_19
Review Article

Aspiration thrombectomy for posterior circulation stroke: A systematic review and meta-analysis

Kevin Sheng
Department of Surgery, University of Sydney, Camperdown, NSW
,
Marcus Tong
1   Department of Surgery, Sir Charles Gairdner Hospital, Nedlands, WA
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Purpose: This study aims to analyze the efficacy of aspiration thrombectomy for large vessel occlusion of the posterior circulation, with an emphasis on comparison with stent retriever thrombectomy. Methods: A systematic review and meta-analysis were performed to analyze the outcomes of aspiration thrombectomy for acute posterior circulation stroke. For those studies that included data for both aspiration and stent-retriever thrombectomy, we additionally performed a second meta-analysis comparing their outcomes against each other. Results: A total of 17 articles were included. For the primary outcomes, the weighted pooled rate of mortality was 26.71% (95% confidence interval [CI] 19.35%–34.71%), modified Ranking Score (mRS) 0–2 at 3 months was 36.71 (95% CI 32.02%–41.52%), and successful recanalization 89.26% (95% CI 83.12%–94.31%). Primary stent retriever thrombectomy was inferior to primary aspiration thrombectomy for the outcomes of successful recanalization (odds ratio [OR] 0.57, 95% CI 0.36–0.91, P = 0.018), complete recanalization (OR 0.65, 95% CI 0.42–0.1.00, P = 0.048), procedure time (mean difference 28.17, 95% CI 9.47–46.87), and rate of embolization to new territory (OR 5.01, 95% CI 1.20–20.87, P = 0.027). No significant difference was seen for other outcomes. Further subgroup analysis suggests that for the outcome of recanalization, this may be dependent on the availability of second-line stent retriever thrombectomy. Limitations: The included studies were observational in nature. There was unresolved heterogeneity in some of the outcomes. Conclusions: There was no statistically significant difference seen for the primary outcomes of mortality and favorable outcome (mRS score 0–2) at 3 months. While superior rates of successful recanalization, complete recanalization, faster procedural time, and improved safety profile for primary aspiration thrombectomy were seen compared to primary stent retriever thrombectomy, this did not translate into superior clinical outcomes.

Key-words:

Aspiration - posterior circulation - stent retriever - stroke - thrombectomy

Financial support and sponsorship

Nil.




Publication History

Received: 29 May 2019

Accepted: 30 June 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723-31.
  • 2 Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: A meta-analysis. JAMA 2016;316:1279-88.
  • 3 Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. T-PA alone in stroke. N Engl J Med 2015;372:2285-95.
  • 4 Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019-30.
  • 5 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49:e46-e110.
  • 6 Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): A randomised controlled trial. Lancet Neurol 2016;15:1138-47.
  • 7 Turk AS, Turner R, Spiotta A, Vargas J, Holmstedt C, Ozark S, et al. Comparison of endovascular treatment approaches for acute ischemic stroke: Cost effectiveness, technical success, and clinical outcomes. J Neurointerv Surg 2015;7:666-70.
  • 8 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 2016;8:230-4.
  • 9 Delgado Almandoz JE, Kayan Y, Young ML, Fease JL, Scholz JM, Milner AM, et al. Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either solumbra or ADAPT techniques. J Neurointerv Surg 2016;8:1123-8.
  • 10 Romano DG, Cioni S, Vinci SL, Pero G, Comelli C, Comai A, et al. Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: Initial experience at nine Italian stroke centers. J Neurointerv Surg 2017;9:6-10.
  • 11 Jankowitz B, Grandhi R, Horev A, Aghaebrahim A, Jadhav A, Linares G, et al. Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: Safety, feasibility and outcomes in 112 consecutive patients. J Neurointerv Surg 2015;7:27-31.
  • 12 Stampfl S, Kabbasch C, Müller M, Mpotsaris A, Brockmann M, Liebig T, et al. Initial experience with a new distal intermediate and aspiration catheter in the treatment of acute ischemic stroke: Clinical safety and efficacy. J Neurointerv Surg 2016;8:714-8.
  • 13 Blanc R, Redjem H, Ciccio G, Smajda S, Desilles JP, Orng E, et al. Predictors of the aspiration component success of a direct aspiration first pass technique (ADAPT) for the endovascular treatment of stroke reperfusion strategy in anterior circulation acute stroke. Stroke 2017;48:1588-93.
  • 14 Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, et al. Effect of endovascular contact aspiration vs. stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: The ASTER randomized clinical trial. JAMA 2017;318:443-52.
  • 15 Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, et al. Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 2014;6:231-7.
  • 16 Fargen KM, Arthur AS, Spiotta AM, Lena J, Chaudry I, Turner RD, et al. Asurvey of neurointerventionalists on thrombectomy practices for emergent large vessel occlusions. J Neurointerv Surg 2017;9:142-6.
  • 17 Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009;151:264-9, W64.
  • 18 Dumont TM, Mokin M, Sorkin GC, Levy EI, Siddiqui AH. Aspiration thrombectomy in concert with stent thrombectomy. BMJ Case Rep 2013;2013. pii: bcr2012010624.
  • 19 Kang DH, Park J. Endovascular stroke therapy focused on stent retriever thrombectomy and direct clot aspiration: Historical review and modern application. J Korean Neurosurg Soc 2017;60:335-47.
  • 20 Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian acute stroke study investigators. Lancet 1998;352:1245-51.
  • 21 U.S. Department of Health and Human Services – National Institutes of Health (NIH). Quality Assessment tool for Before-After (pre-post) Studies with no Control Group; 2014. Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/case_series. [Last accessed on 2019 Feb 10].
  • 22 Alawieh A, Vargas J, Turner RD, Turk AS, Chaudry MI, Lena J, et al. Equivalent favorable outcomes possible after thrombectomy for posterior circulation large vessel occlusion compared with the anterior circulation: The MUSC experience. J Neurointerv Surg 2018;10:735-40.
  • 23 De La Riva P, Navia P, Larrea JA, Palacio E, Castano M, Benavente L, et al. Endovascular recanalization in posterior circulation stroke with aspiration devices is faster, effective and not detrimental to outcome compared to stent retriever devices: The nordictus registry. Eur Stroke J 2018;3 1 Suppl: 188-9.
  • 24 Eom YI, Hwang YH, Hong JM, Choi JW, Lim YC, Kang DH, et al. 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;35:2354-9.
  • 25 Gerber JC, Daubner D, Kaiser D, Engellandt K, Haedrich K, Mueller A, et al. Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion – A retrospective single center experience. Neuroradiology 2017;59:297-304.
  • 26 Giorgianni A, Biraschi F, Piano M, Mardighian D, Gasparotti R, Frigerio M, et al. Endovascular treatment of acute basilar artery occlusion: Registro Endovascolare Lombardo Occlusione Basilar Artery (RELOBA) study group experience. J Stroke Cerebrovasc Dis 2018;27:2367-74.
  • 27 Gory B, Mazighi M, Blanc R, Labreuche J, Piotin M, Turjman F, et al. Mechanical thrombectomy in basilar artery occlusion: Influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs. stent retriever). J Neurosurg 2018;129:1482-91.
  • 28 Haussen DC, Al-Bayati A, Grossberg J, Barreira C, Frankel M, Nogueira RG. Thromboaspiraiton vs. stent retriever thrombectomy for basilar artery occlusion. Stroke 2018;49:11.
  • 29 Kang DH, Jung C, Yoon W, Kim SK, Baek BH, Kim JT, et al. Endovascular thrombectomy for acute basilar artery occlusion: A multicenter retrospective observational study. J Am Heart Assoc 2018;7. pii: e009419.
  • 30 Lee HN, Kim BT, Im SB, Hwang SC, Jeong JH, Chung MY, et al. Implications of mechanical endovascular thrombectomy for acute basilar and posterior cerebral artery occlusion. J Cerebrovasc Endovasc Neurosurg 2018;20:168-75.
  • 31 Li C, Zhao W, Wu C, Shang S, Chen J, Ren M, et al. Outcome of endovascular treatment for acute basilar artery occlusion in the modern era: A single institution experience. Neuroradiology 2018;60:651-9.
  • 32 Mokin M, Sonig A, Sivakanthan S, Ren Z, Elijovich L, Arthur A, et al. Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes. Stroke 2016;47:782-8.
  • 33 Park BS, Kang CW, Kwon HJ, Choi SW, Kim SH, Koh HS, et al. Endovascular mechanical thrombectomy in basilar artery occlusion: Initial experience. J Cerebrovasc Endovasc Neurosurg 2013;15:137-44.
  • 34 Psychogios MN, Kreusch A, Wasser K, Mohr A, Gröschel K, Knauth M. Recanalization of large intracranial vessels using the penumbra system: A single-center experience. AJNR Am J Neuroradiol 2012;33:1488-93.
  • 35 Rentzos A, Karlsson JE, Lundqvist C, Rosengren L, Hellström M, Wikholm G. Endovascular treatment of acute ischemic stroke in the posterior circulation. Interv Neuroradiol 2018;24:405-11.
  • 36 Roth C, Mielke A, Siekmann R, Ferbert A. First experiences with a new device for mechanical thrombectomy in acute basilar artery occlusion. Cerebrovasc Dis 2011;32:28-34.
  • 37 Son S, Choi DS, Oh MK, Hong J, Kim SK, Kang H, et al. Comparison of solitaire thrombectomy and penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg 2016;8:13-8.
  • 38 Uno J, Kameda K, Otsuji R, Ren N, Nagaoka S, Maeda K, et al. Mechanical thrombectomy for acute basilar artery occlusion in early therapeutic time window. Cerebrovasc Dis 2017;44:217-24.
  • 39 Gory B, Eldesouky I, Sivan-Hoffmann R, Rabilloud M, Ong E, Riva R, et al. Outcomes of stent retriever thrombectomy in basilar artery occlusion: An observational study and systematic review. J Neurol Neurosurg Psychiatry 2016;87:520-5.
  • 40 Lindsberg PJ, Sairanen T, Nagel S, Salonen O, Silvennoinen H, Strbian D. Recanalization treatments in basilar artery occlusion-systematic analysis. Eur Stroke J 2016;1:41-50.
  • 41 Mak CH, Ho JW, Chan KY, Poon WS, Wong GK. Intra-arterial revascularization therapy for basilar artery occlusion – A systematic review and analysis. Neurosurg Rev 2016;39:575-80.
  • 42 Wyszomirski A, Szczyrba S, Tomaka D, Karaszewski B. Treatment of acute basilar artery occlusion: Systematic review and meta-analysis. Neurol Neurochir Pol 2017;51:486-96.
  • 43 Weber R, Minnerup J, Nordmeyer H, Eyding J, Krogias C, Hadisurya J, et al. Thrombectomy in posterior circulation stroke: Differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry. Eur J Neurol 2019;26:299-305.
  • 44 Altenbernd J, Kuhnt O, Hennigs S, Hilker R, Loehr C. Frontline ADAPT therapy to treat patients with symptomatic M2 and M3 occlusions in acute ischemic stroke: Initial experience with the penumbra ACE and 3MAX reperfusion system. J Neurointerv Surg 2018;10:434-9.
  • 45 Turk AS, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A, et al. ADAPT FAST study: A direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 2018;10:i4-i7.
  • 46 Peschillo S, Diana F, Berge J, Missori P. A comparison of acute vascular damage caused by ADAPT versus a stent retriever device after thrombectomy in acute ischemic stroke: A histological and ultrastructural study in an animal model. J Neurointerv Surg 2017;9:743-9.
  • 47 Kumar G, Shahripour RB, Alexandrov AV. Recanalization of acute basilar artery occlusion improves outcomes: A meta-analysis. J Neurointerv Surg 2015;7:868-74.
  • 48 Dargazanli C, Consoli A, Barral M, Labreuche J, Redjem H, Ciccio G, et al. Impact of modified TICI 3 versus modified TICI 2b reperfusion score to predict good outcome following endovascular therapy. AJNR Am J Neuroradiol 2017;38:90-6.
  • 49 Stapleton CJ, Leslie-Mazwi TM, Torok CM, Hakimelahi R, Hirsch JA, Yoo AJ, et al. Adirect aspiration first-pass technique vs stentriever thrombectomy in emergent large vessel intracranial occlusions. J Neurosurg 2018;128:567-74.
  • 50 Massari F, Henninger N, Lozano JD, Patel A, Kuhn AL, Howk M, et al. ARTS (Aspiration-retriever technique for stroke): Initial clinical experience. Interv Neuroradiol 2016;22:325-32.
  • 51 Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE, et al. First pass effect: A new measure for stroke thrombectomy devices. Stroke 2018;49:660-6.
  • 52 Mortimer AM, Bradley M, Renowden SA. Endovascular therapy for acute basilar artery occlusion: A review of the literature. J Neurointerv Surg 2012;4:266-73.
  • 53 Brinjikji W, Starke RM, Murad MH, Fiorella D, Pereira VM, Goyal M, et al. Impact of balloon guide catheter on technical and clinical outcomes: A systematic review and meta-analysis. J Neurointerv Surg 2018;10:335-9.
  • 54 Alawieh A, Chatterjee AR, Vargas J, Chaudry MI, Lena J, Turner R, et al. Lessons learned over more than 500 stroke thrombectomies using ADAPT with increasing aspiration catheter size [e-pub ahead of print]. Neurosurgery. 2018. Available from: https://doi.org/10.1093/neuros/nyy444. [Last accessed on 2019 Feb 04].
  • 55 Ouyang F, Chen Y, Zhao Y, Dang G, Liang J, Zeng J. Selection of patients and anesthetic types for endovascular treatment in acute ischemic stroke: A meta-analysis of randomized controlled trials. PLoS One 2016;11:e0151210.
  • 56 Mueller-Kronast NH, Zaidat OO, Froehler MT, Jahan R, Aziz-Sultan MA, Klucznik RP, et al. Systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke: Primary results of the STRATIS registry. Stroke 2017;48:2760-8.