Safety and Efficacy Outcomes of Catheter-assisted Mechanical Thrombectomy Versus Catheter-assisted Aspiration Thrombectomy in Patients with Acute MCA Occlusion Stroke: A Systematic Review and Meta-analysis
Rida Shakeel1, Zain Ul Abedin2, Javed Iqbal3, Safa Mazhar4, Raghabendra kumar Mahato5, Rabia Asim6, Anas Mansour7, Muhammad Abdullah Khan8, Huzaifa Nawaz9, Sohaib Aftab Ahmad Chaudhry10, Hafiz Sohail Ashraf11
1Dow University of Health Sciences, 2King Edward Medical University, Lahore, Pakistan, 3Hamad Medical Corporation, Doha, Qatar, 4Jinnah Sindh Medical University, Karachi, Pakistan, 5Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal, 6Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Karachi, Pakistan, 7Al-Azhar University, Cairo, Egypt, 8Federal Medical College, Islamabad., 9Services Institute of Medical Sciences (SIMS), Ghaus-ul-Azam Jail Road, Lahore, Pakistan 54000, 10ABWA Medical College, Faisalabad, Pakistan, 11Carle foundation Hospital Urbana Illinois
Objective:
To compare the safety and efficacy of catheter-assisted mechanical thrombectomy (using stent retrievers) versus catheter-assisted aspiration thrombectomy in patients with acute middle cerebral artery (MCA) occlusion stroke, focusing on functional recovery, mortality, and procedural efficiency.
Background:
Acute ischemic stroke due to MCA occlusion is a leading cause of mortality and disability. Endovascular thrombectomy is the standard for large vessel occlusions. This systematic review and meta-analysis evaluates outcomes of catheter-assisted mechanical thrombectomy (stent retrievers, SR) versus catheter-assisted aspiration thrombectomy (CAT).
Design/Methods:
Following PRISMA and Cochrane guidelines, we searched PubMed, Scopus, EMBASE, and Google Scholar up to July 2025. Included studies were randomized controlled trials (RCTs) and cohort studies. Continuous outcomes were analyzed using mean difference (MD) or standardized mean difference (SMD), and categorical outcomes used odds ratios (OR) with 95% confidence intervals (CIs). Heterogeneity was assessed with I² and Chi-square tests.
Results:
Eight studies (four retrospective cohorts, three prospective cohorts, one RCT) were included. No significant differences were observed between CAT and SR in 90-day functional independence (RR = 1.14, 95% CI = 0.93–1.39) or mortality (RR = 0.97, 95% CI = 0.72–1.31). Symptomatic intracranial hemorrhage rates were comparable, with CAT showing a nonsignificant trend toward lower risk. CAT achieved faster recanalization (MD = –38 min, p = 0.0008) and shorter procedure times (MD = –27 min, p = 0.028), despite heterogeneity. First-pass effect, NIHSS improvement, onset-to-groin puncture time, and rescue therapy requirements showed no significant differences.
Conclusions:
CAT offers procedural advantages with faster recanalization and shorter procedure times compared to SR, without compromising functional recovery, mortality, or safety outcomes. Further trials are needed to strengthen evidence for specific population subgroups.
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