Functional outcomes & recanalisation rates of stent retrievers in acute ischaemic stroke: a systematic review & meta-analysis Abstract: Background: Intra-arterial therapy for acute ischemic stroke has evolved rapidly in the last few years. Stent retrievers have now replaced ‘first-generation’ devices which have been the principle devices tested in stroke trials. Our aims were to determine the rates of successful recanalisation and functional independence in acute stroke patients treated with stent retrievers. We also sought to assess the safety outcomes of stent retrievers by assessing the rates of mortality and intra-cranial haemorrhage. Method: We conducted a systematic review and meta-analysis of studies which utilised stent retrievers as sole treatment or as part of a multi-modal approach in acute ischaemic stroke. Results: We identified 20 eligible studies: 17 on Solitaire (ev3/Covidien, Irvine, California, USA) (n=762) and 3 on Trevo (Stryker, Kalamazoo, Michigan, USA) (n=210). The mean age of participants was 66.8 (range 62.1-73.0) years and the M:F ratio was 1.1:1. The average stroke severity score (NIHSS) at presentation was 17.2 (range 13-21.4). The weighted mean symptom onset to arterial puncture and procedural duration were 265.4 (range 154-462.5) minutes and 54.8 (range 33-95.9) minutes respectively. Successful recanalisation (defined as TICI score of 2b–3 or TIMI score of 2-3) was achieved in 84.5% (20 comparisons; 95%CI 0.811, 0.888; p<0.001) of patients with a weighted mean of 2.0 (range 1.4-2.5) stent retriever passes. Independent functional outcome (mRS≤2) was achieved in 51.2% (19 comparisons; 95%CI 0.461, 0.562; p=0.653) and the mortality rate was 16.8% (19 comparisons; 95%CI 0.132, 0.211; p<0.001). 22.0% (14 comparisons; 95%CI 0.169, 0.281; p<0.001) of patients suffered intracranial haemorrhage of which only 7.6% (17 comparisons; 95%CI 0.056, 0.102; p<0.001) were symptomatic (sICH). Conclusion: Stent retrievers have the potential to achieve a high rate of recanalisation and functional independence whilst being relatively safe. They are superior to ‘first generation’ embolectomy devices which were utilised in most RCTs comparing intravenous rt-PA to mechanical thrombectomy. Stent retrievers should be assessed in well-designed RCTs to determine their efficacy and assess whether they compare favourably to ‘standard treatment’ in stroke. Project type: Meta-analysis Systematic review Imaging keywords: Application / disease keywords: Acute ischemic stroke Intracranial haemorrhage Supervisor(s): Dr Jonathan Downer Programme: Neuroimaging for Research MSc Year: 13-14 This article was published on 2024-08-22
