Endovascular Thrombectomy for Acute Ischemic Stroke due to Distal Medium Vessel Occlusion: A Systematic Review and Meta-analysis
Muhammad Aemaz Ur Rehman1, FNU Javairia2, Ramla Ejaz3, Ayesha Imran4, Rabbiya Ali5, Mahnoor Shaikh6, Momina Abid7, Amna Ali Malik8, Warda Fatmi9
1University of Alabama, 2Allama Iqbal Medical College, 3Ameer-ud-Din Medical College, 4Dow International Medical College, 5Jinnah Sindh Medical University, 6Dow Medical College, 7University Medical and Dental College, 8Ziauddin Medical University, 9Civil hospital Karachi , Dow Medical College
Objective:
Studies exploring the efficacy of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVOs) have shown conflicting results. We thus performed a systematic review and meta-analysis to compare its efficacy and safety with the best medical therapy (BMT) in treating primary DMVOs.
Background:
EVT is well recognized as an effective treatment for proximal large vessel occlusions (LVOs) but its use for DMVOs remains a topic of scientific discussion. EVTs in distal medium vessel occlusions were considered high-risk due to reduced vessel size and tortuosity, but newer techniques and recent efforts to explore the EVT potential have encouraged us to revisit thrombectomy indications.
Design/Methods:
A comprehensive search was performed on Pubmed and Google Scholar from inception to October 2023. Efficacy outcomes of interest included functional independence (90-day modified Rankin scale (mRS) 0–2) and excellent functional outcomes (90-day mRS 0–1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Statistical analysis was performed on Review Manager (RevMan) version 5.3.
Results:
Seventeen observational studies and two randomized controlled trials were included in this meta-analysis with a total sample size of 2973; 1525 patients receiving EVT and 1448 patients receiving BMT. Our preliminary analysis showed that there is no significant difference between EVT and BMT in terms of functional independence (OR 0.97 , 95% CI 0.81-1.16 , p value 0.75), excellent functional outcomes (OR 1.19 , 95% CI 0.96-1.48 , p value 0.11), sICH ( OR 1.55 , 95% CI 0.71-3.36 , p value 0.27) and mortality ( OR 0.94 , 95% CI 0.73-1.23 p value 0.67).
Conclusions:
BMT is comparable to EVT in ischemic stroke due to distal medium vessel occlusions (AIS-DMVOs). However, the limited number of RCTs and lack of subgroup or sensitivity analysis in our preliminary results warrant cautious interpretation.