Should the direct aspiration first pass technique be advocated over the stent-retriever technique for acute ischemic stroke? A systematic review and meta-analysis of 7692 patients.

Journal: Surgical neurology international

Volume: 12

Issue: 

Year of Publication: 

Affiliated Institutions:  Faculty of Medicine, Zagazig University, Zagazig University, Zagazig, Sharkia, Egypt. Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Faculty of Medicine, South Valley University, Qena, Egypt. Omar Shahin Mental Hospital, Cairo, Egypt. Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, Egypt. Department of Neurosurgery, National Bank Hospital, Cairo, Egypt. Faculty of Medicine, Al-Azhar University, New Damietta, Egypt. Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon, Africa. Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon, Africa. Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, United States.

Abstract summary 

The present meta-analysis aimed to synthesize evidence from all published studies with head-to-head data on the outcomes of a direct aspiration first pass technique (ADAPT) and the stent-retriever (SR) in acute ischemic stroke (AIS) patients.We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to March 2021 for relevant clinical trials and observational studies. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis random-effects model of DerSimonian-Laird.Thirty studies were included in the meta-analysis with a total of 7868 patients. Compared with the SR, the ADAPT provides slightly higher rates of successful recanalization (RR 1.06, 95% CI [1.02 to 1.10]) and complete recanalization (RR 1.20, 95% CI [1.01 to 1.43]) but with more need for rescue therapy (RR 1.81, 95% CI [1.29 to 2.54]). There were no significant differences between the two techniques in terms of mortality at discharge, mortality at 90 days, change in the National Institutes of Health Stroke Scale score, the favorable outcome (modified Rankin scale (mRS) of 0-2), time to the groin puncture, or frequency of complications as intracerebral hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), embolus in a new territory (ENT), hemorrhagic infarction, parenchymal hematoma, subarachnoid hemorrhage, or procedural complications (all > 0.05).Current evidence supports the use of the ADAPT technique to achieve successful and complete recanalization while considering the higher need for rescue therapy in some patients.

Authors & Co-authors:  Negida Ahmed A Ghaith Hazem S HS Gabra Mohamed Diaa MD Aziz Mohamed Abdelalem MA Elfil Mohamed M Al-Shami Haider H Bahbah Eshak I EI Kanmounye Ulrick Sidney US Esene Ignatius I Raslan Ahmed M AM

Study Outcome 

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Statistics
Citations :  Adams HP, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH stroke scale score strongly predicts outcome after stroke: A report of the trial of org 10172 in acute stroke treatment (TOAST) Neurology. 1999;53:126–31.
Authors :  10
Identifiers
Doi : 597
SSN : 2229-5097
Study Population
Male,Female
Mesh Terms
Other Terms
A direct aspiration first pass technique;Direct aspiration first pass technique;Endovascular therapy;Ischemic stroke;Meta-analysis;Stent retriever;Thrombectomy
Study Design
Cross Sectional Study
Study Approach
Systemic Review
Country of Study
Publication Country
United States