What question did this study set out to answer?

To evaluate and compare mechanical thrombectomy techniques and their effects on reperfusion success, safety, and mortality in patients with acute large vessel occlusion strokes.

May 8, 2026Open Access

Abstract Number: Esoc2026lb71 Technique Selection in Mechanical Thrombectomy for Acute Large Vessel Occlusion , a Systematic Review and Meta-Analysis

Key Points

To evaluate and compare mechanical thrombectomy techniques and their effects on reperfusion success, safety, and mortality in patients with acute large vessel occlusion strokes.
Systematic review and meta-analysis of interventional techniques: aspiration-first, stent retriever-first, combined techniques, and balloon guide catheter use.
Analysis of outcomes included reperfusion success, first-pass effect, 90-day functional independence, and mortality, using random-effects risk ratios with 95% confidence intervals.
Stent retriever techniques achieved high reperfusion rates (~79–86%) and functional outcomes (~45–52%), albeit with a modest first-pass effect (~24%).
Combined techniques enhanced first-pass and final reperfusion rates (~88%) and improved functional independence; balloon guide catheter usage correlated with reduced mortality.
Overall, no significant differences were found in all-cause mortality (RR 0.89) or adverse events (RR 1.00); however, adjunctive techniques increased reperfusion success (RR 1.09), with low–moderate evidence.

Abstract

Abstract Background and aims INTRODUCTION Acute ischemic stroke from large vessel occlusion remains a major cause of mortality and disability. Despite mechanical thrombectomy as standard care, technique selection varies widely. Optimizing first-pass reperfusion while minimizing distal embolization is critical, yet no standardized evidence-based framework currently guides procedural choice. OBJECTIVES 1. Systematically evaluate evidence comparing mechanical thrombectomy techniques. 2. Assess the impact of technique selection on: • Reperfusion success • Safety outcomes • All-cause mortality 3. Inform a patient-specific, evidence-based approach to technique selection in interventional neuroradiology. Methods METHODOLOGY Systematic review and meta-analysis of adults with acute large vessel occlusion stroke comparing aspiration-first, stent retriever–first, combined techniques, and balloon guide catheter use. Outcomes included reperfusion success, first-pass effect, 90-day functional independence, mortality, and procedural complications, analyzed using random-effects risk ratios with 95% confidence intervals. Results Stent retriever (SR) SR has modest first-pass effect (~24%) and ~8% sICH. •Combined SR + aspiration / BGC: Improves first-pass and final reperfusion (~88%) and functional independence; BGC reduces mortality. •Meta-analysis: No difference in all-cause mortality (RR 0.89) or adverse events (RR 1.00); adjunctive/combined techniques increase reperfusion success (RR 1.09), evidence low–moderate. Conclusions Mechanical thrombectomy technique selection significantly affects reperfusion efficiency without altering overall mortality or safety outcomes. Stent retriever and aspiration-first approaches are equivalent first-line strategies, while combined techniques and balloon guide catheter use enhance reperfusion quality in selected patients. An individualized, anatomy- and clot-based approach is essential to optimize outcomes in interventional stroke therapy. Conflict of interest

Abstract Number: Esoc2026lb71 Technique Selection in Mechanical Thrombectomy for Acute Large Vessel Occlusion , a Systematic Review and Meta-Analysis

Key Points

Abstract

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