Key result
Stent retriever thrombectomy yields ~2.3-fold higher odds of good functional recovery in LVO stroke.
Why the study?
Various mechanical thrombectomy strategies, including stent retriever, aspiration, and their combination, are widely used for acute ischemic stroke due to large vessel occlusion, but the optimal approach remains unclear.
Does mechanical thrombectomy using stent retriever, aspiration, or their combination improve recanalization and functional outcomes in patients with large vessel occlusion stroke?
Meta-Analysis
Does mechanical thrombectomy using stent retriever, aspiration, or their combination improve recanalization and functional outcomes in patients with large vessel occlusion stroke?
In large vessel occlusion acute ischemic stroke, stent retriever thrombectomy has the highest probability of achieving recanalization and good 90-day functional outcomes, while combined stent retriever and aspiration is most likely to reduce 90-day mortality.
Answers are grounded in this paper and cite their sources.
Supports stent retriever as preferred LVO thrombectomy technique; extends RCT network evidence by ranking functional and recanalization outcomes.
BACKGROUND: Mechanical thrombectomy (MT) is a key intervention for acute ischemic stroke due to large vessel occlusion (LVO). Various MT strategies - stent retriever (SR), aspiration (Asp), and their combination (SR + Asp) - are widely used, but the optimal approach remains unclear. OBJECTIVES: This network meta-analysis (NMA) aimed to compare the efficacy and safety of these techniques using evidence from randomized controlled trials (RCTs). MATERIALS AND METHODS: A Bayesian NMA was conducted, including RCTs evaluating different MT techniques in LVO-related stroke. The primary outcome was successful recanalization (thrombolysis in cerebral infarction ≥2b) and good functional outcome (modified Rankin Scale ≤2 at 90 days). Secondary outcomes included all-cause mortality at 90 days and symptomatic intracranial hemorrhage (sICH) within 24 h. Odds ratios (ORs) with 95% credible intervals (CrIs) were calculated using a Bayesian random-effects model. RESULTS: Twenty-seven RCTs were analyzed. Within the current evidence network, SR demonstrated the highest probability of good functional recovery (OR = 2.27; 95% CrI: 1.72-3.02) and successful recanalization (OR = 13.6; 95% CrI: 3.12-75.0). SR + Asp demonstrated the highest probability of reducing 90-day mortality (OR = 0.771; 95% CrI: 0.638-0.929). Rates of sICH were broadly comparable across thrombectomy strategies, although SR and SR + Asp showed higher estimated odds than standard treatment (ST). CONCLUSIONS: This NMA suggests that SR thrombectomy has the highest probability of achieving successful recanalization and favourable functional outcomes, whereas combined (SR + Asp) showed the highest probability of reducing mortality within the current evidence network. These probability-based rankings should be interpreted cautiously because they were derived from a heterogeneous network with limited direct head-to-head comparisons. Future adequately powered randomized trials directly comparing thrombectomy strategies are required before definitive recommendations can be made.
No takes yet. Share an insight, caveat, or question.
Gulia et al. (2026) conducted a meta-analysis in Acute ischemic stroke due to large vessel occlusion (LVO). Mechanical thrombectomy (stent retriever [SR], aspiration [Asp], and combined SR + Asp) vs. Standard treatment (ST) and alternate mechanical thrombectomy strategies was evaluated on Successful recanalization (thrombolysis in cerebral infarction ≥2b) and good functional outcome (modified Rankin Scale ≤2 at 90 days) (OR 2.27, 95% CI 1.72-3.02). Stent retriever thrombectomy showed the highest probability of good functional recovery (OR 2.27; 95% CrI 1.72-3.02) and successful recanalization (OR 13.6; 95% CrI 3.12-75.0) in LVO stroke.
Synapse has enriched 10 related papers. Consider them for comparative context: