| Summary: | Aim: Stent-retriever (SR) thrombectomy has demonstrated superior outcomes in patients with acute
ischemic stroke compared with medical management alone, but differences among SRs remain
unexplored. We conducted a Systematic Review/Meta-Analysis to compare outcomes between three SRs:
EmboTrap R , Solitaire™, and TrevoR . Methods: We conducted a PRISMA-compliant Systematic Review
among English-language studies published after 2014 in PubMed/MEDLINE that reported SRs in ≥25
patients. Functional and safety outcomes included 90-day modified Rankin scale (mRS 0-2), mortality,
symptomatic intracranial hemorrhage (sICH), and embolization to new territory (ENT). Recanalization
outcomes included modified thrombolysis in cerebral infarction (mTICI) and first-pass recanalization (FPR).
We used a random effects Meta-Analysis to compare outcomes; subgroup and outlier-influencer analysis
were performed to explore heterogeneity. Results: Fifty-one articles comprising 9,804 patients were
included. EmboTrap had statistically significantly higher rates of mRS 0-2 (57.4%) compared with Trevo
(50.0%, p = 0.013) and Solitaire (45.3%, p < 0.001). Compared with Solitaire (20.4%), EmboTrap (11.2%,
p < 0.001) and Trevo (14.5%, p = 0.018) had statistically significantly lower mortality. Compared with
Solitaire (7.7%), EmboTrap (3.9%, p = 0.028) and Trevo (4.6%, p = 0.049) had statistically significantly
lower rates of sICH. There were no significant differences in ENT rates across all three devices (6.0% for
EmboTrap, 5.3% for Trevo, and 7.7% for Solitaire, p = 0.518). EmboTrap had numerically higher rates of
recanalization; however, no statistically significant differences were found. Conclusion: The results of our
Systematic Review/Meta-Analysis suggest that EmboTrap may be associated with significantly improved
functional outcomes compared with Solitaire and Trevo. EmboTrap and Trevo may be associated with
significantly lower rates of sICH and mortality compared with Solitaire. No significant differences in
recanalization and ENT rates were found. These conclusions are tempered by limitations of the analysis
including variations in thrombectomy techniques in the field, highlighting the need for multi-arm RCT
studies comparing different SR devices to confirm our findings.
|
|---|