Meta-Analysis of the Efficacy and Safety of Aspiration Thrombectomy and Stent Retriever Thrombectomy in the Treatment of Acute Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2025.08.008

Abstract

Abstract: Objective To explore the efficacy and safety of aspiration thrombectomy and stent retriever thrombectomy in the treatment of acute ischemic stroke (AIS).
Methods Chinese and English databases, including PubMed, Cochrane Library, Embase, CNKI, Wanfang, and VIP, were searched to screen studies comparing the efficacy of aspiration thrombectomy and stent retriever thrombectomy in AIS. The efficacy indicators included 90-day mRS score, successful recanalization, and puncture-to-recanalization time. The safety indicators included hemorrhagic transformation, 90-day all-cause mortality, and other complications (vascular perforation/dissection, vasospasm, and new-onset embolism). The funnel plot was used to assess the risk of bias among the included studies. Meta-analysis was performed using RevMan 5.3 software.
Results A total of 35 studies involving 4865 patients were included. In terms of efficacy, the aspiration thrombectomy group demonstrated superior 90-day mRS scores than the stent retriever thrombectomy group (OR 1.44, 95%CI 1.03-2.00, P=0.030), higher successful recanalization rates than the stent retriever thrombectomy group (OR 1.50, 95%CI 1.18-1.92, P<0.001), and shorter puncture-to-recanalization time than the stent retriever thrombectomy group [standardized mean difference (SMD) -6.57, 95%CI -7.80--5.34, P<0.001]. In terms of safety, there were no statistically significant differences between the two techniques in hemorrhagic transformation rate (OR 0.92, 95%CI 0.76-1.12, P=0.410), 90-day all-cause mortality (OR 0.86, 95%CI 0.64-1.16, P=0.310), and the rates of other complications (OR 0.91, 95%CI 0.75-1.09, P=0.330).
Conclusions Compared with stent retriever thrombectomy, aspiration thrombectomy has similar safety for treating AIS, but has certain advantages in the successful recanalization rate and short-term prognosis, with a shorter puncture-to-recanalization time.

Key words: Acute ischemic stroke; Aspiration thrombectomy; Stent retriever thrombectomy; Meta-analysis

摘要： 目的探讨抽吸取栓与支架取栓治疗急性缺血性卒中（acute ischemic stroke，AIS）的有效性及安全性。
方法检索PubMed、Cochrane Library、Embase、中国知网、万方、维普等中英文数据库，筛选比较抽吸取栓与支架取栓治疗AIS效果的研究。有效性指标包括90 d mRS评分、血管再通成功和穿刺至血管再通时间；安全性指标包括出血转化、90 d全因死亡和其他并发症（血管穿孔及夹层、血管痉挛、新发栓塞）。采用漏斗图对纳入研究进行偏倚风险评估。使用RevMan 5.3软件进行meta分析。
结果共纳入35项研究，包括4865例患者。在有效性方面，抽吸取栓组的90 d mRS评分优于支架取栓组（OR 1.44，95%CI 1.03～2.00，P＝0.030），血管再通成功率高于支架取栓组（OR 1.50，95%CI 1.18～1.92，P＜0.001），穿刺至血管再通时间短于支架取栓组[标准化均数差（standardized mean difference，SMD）－6.57，95%CI －7.80～－5.34，P＜0.001]。在安全性方面，两种术式的出血转化率（OR 0.92，95%CI 0.76～1.12，P＝0.410）、90 d全因死亡率（OR 0.86，95%CI 0.64～1.16，P＝0.310）和其他并发症发生率（OR 0.91，95%CI 0.75～1.09，P＝0.330）的差异均无统计学意义。
结论与支架取栓相比，抽吸取栓治疗AIS的安全性相似，但在血管再通成功率及短期预后方面具有一定的优势，且穿刺至血管再通时间较短。

关键词: 急性缺血性卒中; 抽吸取栓; 支架取栓; meta分析

CLC Number:

LIU Anli, XUE Qian, YANG Jinshui, MIAO Ruirui, WANG Huanhuan. Meta-Analysis of the Efficacy and Safety of Aspiration Thrombectomy and Stent Retriever Thrombectomy in the Treatment of Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(8): 992-1005.

刘安利, 薛茜, 杨金水, 苗瑞瑞, 王欢欢. 抽吸取栓与支架取栓治疗急性缺血性卒中有效性及安全性的meta分析[J]. 中国卒中杂志, 2025, 20(8): 992-1005.

References

[1] JAUCH E C，SAVER J L，ADAMS H P，Jr，et al. Guidelines for the early management of patients with acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke，2013，44（3）：870-947.
[2] WELLS G A，SHEA B，O’CONNELL D，et al. The Newcastle-Ottawa scale（NOS）for assessing the quality of nonrandomised studies in meta-analyses[EB/OL].（2022-04-25）[2024-10-14]. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
[3] BREHM A，MAUS V，TSOGKAS I，et al. Stent-retriever assisted vacuum-locked extraction（SAVE）versus a direct aspiration first pass technique（ADAPT）for acute stroke：data from the real-world[J]. BMC Neurol，2019，19（1）：65-73.
[4] MARTINI M，MOCCO J，TURK A，et al. Real-world comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation：a multicenter international retrospective study[J]. J Neurointerv Surg，2019，11（10）：957-963.
[5] YOO J，LEE S J，HONG J H，et al. Immediate effects of first-line thrombectomy devices for intracranial atherosclerosis-related occlusion：stent retriever versus contact aspiration[J]. BMC Neurol，2020，20（1）：283-293.
[6] BERNSEN M L E，GOLDHOORN R B，VAN OOSTENBRUGGE R J，et al. Equal performance of aspiration and stent retriever thrombectomy in daily stroke treatment[J]. J Neurointerv Surg，2019，11（7）：631-636.
[7] DELGADO ALMANDOZ J E，KAYAN Y，YOUNG M L，et al. Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques[J]. J Neurointerv Surg，2016，8（11）：1123-1128.
[8] GORY B，LAPERGUE B，BLANC R，et al. Contact aspiration versus stent retriever in patients with acute ischemic stroke with M2 occlusion in the ASTER randomized trial（contact aspiration versus stent retriever for successful revascularization）[J]. Stroke，2018，49（2）：461-464.
[9] LAPERGUE B，BLANC R，GUEDIN P，et al. A direct aspiration，first pass technique（ADAPT）versus stent retrievers for acute stroke therapy：an observational comparative study[J]. AJNR Am J Neuroradiol，2016，37（10）：1860-1865.
[10] XIA L，ZHAO P P，SUN H X，et al. Comparision of mechanical thrombectomy with contact aspiration or stent retriever in patients with large-vessel occlusion in acute ischemic stroke[J/OL]. J Craniofac Surg，2021，32（4）：e364-e366[2024-10-14]. https://doi.org/10.1097/scs.0000000000007264.
[11] BERNSEN M L E，BRUGGEMAN A A E，BROUWER J，et al. Aspiration versus stent retriever thrombectomy for posterior circulation stroke[J]. Stroke，2022，53（3）：749-757.
[12] QIU K，ZHAO L B，XU X Q，et al. Acute embolic stroke with large-vessel occlusion：does contact aspiration thrombectomy show superiority？[J]. Clin Radiol，2022，77（8）：577-583.
[13] HUANG Y J，SHU X H，HUANG L T，et al. The evaluation and treatment of acute anterior circulation occlusion stroke with high clot burden：progressive stratified aspiration thrombectomy vs. stent retriever thrombectomy[J/OL]. Clin Neurol Neurosurg，2023，230：107793[2024-10-14]. https://doi.org/10.1016/j.clineuro.2023.107793.
[14] ONODERA K，KURISU K，SAKURAI J，et al. A direct aspiration first pass technique for vertebra-basilar occlusion：a retrospective comparison to stent retriever[J/OL]. J Stroke Cerebrovasc Dis，2021，30（11）：106069[2024-10-14]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106069.
[15] TURK A S，3rd，CAMPBELL J M，SPIOTTA A，et al. An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke[J]. J Neurointerv Surg，2014，6（1）：77-80.
[16] TURK A S，3rd，SIDDIQUI A，FIFI J T，et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion（COMPASS）：a multicentre，randomised，open label，blinded outcome，non-inferiority trial[J]. Lancet，2019，393（10175）：998-1008.
[17] LAPERGUE B，BLANC R，GORY B，et al. Effect of endovascular contact aspiration vs. stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion：the ASTER randomized clinical trial[J]. JAMA，2017，318（5）：443-452.
[18] SILA D，LENSKI M，VOJTKOVÁ M，et al. Efficacy of mechanical thrombectomy using penumbra ACETM aspiration catheter compared to stent retriever SolitaireTM FR in patients with acute ischemic stroke[J/OL]. Brain Sci，2021，11（4）：504[2024-10-14]. https://doi.org/10.3390/brainsci11040504.
[19] 倪福文，李成颖，陈水洪，等. SOFIA PLUS远端通路导管抽吸取栓与SOLITAIRE支架系统支架取栓在急性颅内大动脉闭塞中的应用[J]. 中国当代医药，2021，28（21）：52-54.
NI F W，LI C Y，CHEN S H，et al. Application of SOFIA PLUS distal access catheter aspiration thrombectomy versus SOLITAIRE stent system retrieval thrombectomy in acute intracranial large artery occlusion[J]. China Modern Medicine，2021，28（21）：52-54.
[20] 靳振明. 急性脑梗死支架取栓与抽吸取栓效果评价[J/OL]. 理论研究，2020：1163-1164[2024-10-14]. https://doi.org/10.12252/j.issn.2096-6261.2020.02.580.
JIN Z M. Efficacy evaluation of stent retriever versus aspiration thrombectomy for acute cerebral infarction[J/OL]. Theoretical Research，2020：1163-1164[2024-10-14]. https://doi.org/10.12252/j.issn.2096-6261.2020.02.580.
[21] 马浩源，赵岩，胡明，等. SOFIA远端通路导管直接血栓抽吸和支架取栓治疗早期急性缺血性脑卒中疗效比较[J]. 中国神经精神疾病杂志，2020，46（4）：216-220.
MA H Y，ZHAO Y，HU M，et al. Comparison of the efficacy between SOFIA distal access catheter direct aspiration and stent retriever thrombectomy in early acute ischemic stroke[J]. Chinese Journal of Nervous and Mental Diseases，2020，46（4）：216-220.
[22] 王晓东，秦兆为，罗志松，等. 抽吸取栓和支架取栓治疗急性缺血性脑卒中的疗效对比分析[J]. 中华神经创伤外科电子杂志，2022，8（2）：81-86.
WANG X D，QIN Z W，LUO Z S，et al. Comparative analysis of the efficacy between aspiration thrombectomy and stent retriever thrombectomy in acute ischemic stroke[J]. Chinese Journal of Neurotraumatic Surgery，2022，8（2）：81-86.
[23] 朱国，吴达，周志平，等. 抽吸取栓术与支架取栓术治疗前循环心源性脑栓塞患者的安全性和有效性分析[J]. 中国脑血管病杂志，2022，19（12）：817-823.
ZHU G，WU D，ZHOU Z P，et al. Safety and efficacy analysis of aspiration thrombectomy versus stent retriever thrombectomy for anterior circulation cardioembolic stroke[J]. Chinese Journal of Cerebrovascular Diseases，2022，19（12）：817-823.
[24] 黄良通，詹艳丽，徐灵燕，等. 抽吸取栓术治疗急性颅内大血管闭塞的临床疗效[J]. 浙江实用医学，2020，25（4）：261-263.
HUANG L T，ZHAN Y L，XU L Y，et al. Clinical efficacy of aspiration thrombectomy in acute intracranial large vessel occlusion[J]. Zhejiang Practical Medicine，2020，25（4）：261-263.
[25] 袁正洲，杨元，李经伦，等. 抽吸取栓与支架取栓治疗急性后循环大血管闭塞的效果分析[J]. 中国脑血管病杂志，2021，18（12）：821-828.
YUAN Z Z，YANG Y，LI J L，et al. Efficacy analysis of aspiration thrombectomy versus stent retriever thrombectomy in acute posterior circulation large vessel occlusion[J]. Chinese Journal of Cerebrovascular Diseases，2021，18（12）：821-828.
[26] 蒋学文，赫利寒. 单纯中间导管抽吸取栓与支架取栓对急性前循环大血管闭塞性脑卒中疗效分析[J]. 中国疗养医学，2022，31（4）：443-445.
JIANG X W，HE L H. Efficacy analysis of pure intermediate catheter aspiration thrombectomy versus stent thrombectomy for acute anterior circulation large vessel occlusive stroke[J]. Chinese Journal of Convalescent Medicine，2022，31（4）：443-445.
[27] 罗政云，陈轲，付航. 导管抽吸取栓与支架取栓治疗急性缺血性脑卒中的疗效比较研究[J]. 实用心脑肺血管病杂志，2022，30（1）：58-63.
LUO Z Y，CHEN K，FU H. Comparative study on the efficacy of catheter aspiration thrombectomy versus stent thrombectomy in the treatment of acute ischemic stroke[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease，2022，30（1）：58-63.
[28] 陈立洲，李文会，朱军，等. 对比分析抽吸取栓与支架取栓治疗前循环大血管急性栓塞性闭塞的临床疗效[J]. 中华介入放射学电子杂志，2023，11（1）：35-41.
CHEN L Z，LI W H，ZHU J，et al. Comparative analysis of the clinical efficacy between aspiration thrombectomy and stent thrombectomy in the treatment of acute embolic occlusion of anterior circulation large vessels[J]. Chinese Journal of Interventional Radiology，2023，11（1）：35-41.
[29] 郭章宝，许项前，谌敏，等. 急性大脑中动脉M2段闭塞致缺血性卒中支架取栓术与直接抽吸取栓术对比分析[J]. 中国现代神经疾病杂志，2022，22（9）：810-816.
GUO Z B，XU X Q，CHEN M，et al. Comparative analysis of stent retriever thrombectomy versus direct aspiration thrombectomy for acute ischemic stroke caused by M2 segment occlusion of middle cerebral artery[J]. Chinese Journal of Contemporary Neurology and Neurosurgery，2022，22（9）：810-816.
[30] 张国建. 急性缺血性脑卒中行直接抽吸取栓与支架取栓的疗效[J]. 吉林医学，2022，43（10）：2686-2688.
ZHANG G J. Efficacy of direct aspiration thrombectomy versus stent retriever thrombectomy in acute ischemic stroke[J]. Jilin Medical Journal，2022，43（10）：2686-2688.
[31] 朱晨. 接触抽吸技术治疗大脑中动脉M2段急性闭塞的疗效及安全性分析[J]. 中西医结合心脑血管病杂志，2021，19（14）：2439-2442.
ZHU C. Efficacy and safety analysis of contact aspiration technique in the treatment of acute M2 segment occlusion of middle cerebral artery[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease，2021，19（14）：2439-2442.
[32] 汪宁，温昌明，高军，等. 栓塞性急性椎基底动脉闭塞首选取栓策略的比较研究[J]. 中华神经医学杂志，2022，21（12）：1226-1231.
WANG N，WEN C M，GAO J，et al. Comparative study of first-line thrombectomy strategies for embolic acute vertebrobasilar artery occlusion[J]. Chinese Journal of Neuromedicine，2022，21（12）：1226-1231.
[33] 敖峰，贺嘉男，刘汉伟，等. 血栓抽吸（ADAPT）与支架取栓在治疗急性大血管闭塞性脑梗死的比对研究[J]. 中华介入放射学电子杂志，2020，8（1）：24-27.
AO F，HE J N，LIU H W，et al. Comparative study of thrombus aspiration（ADAPT）versus stent retrieval in the treatment of acute large vessel occlusive cerebral infarction[J]. Chinese Journal of Interventional Radiology（Electronic Edition），2020，8（1）：24-27.
[34] 刘华，牛彦龙，万栋栋，等. 支架取栓与抽吸取栓治疗急性前循环闭塞的效果对比[J]. 宁夏医学杂志，2023，45（4）：345-347.
LIU H，NIU Y L，WAN D D，et al. Comparative effectiveness of stent retriever versus aspiration thrombectomy in acute anterior circulation occlusion[J]. Ningxia Medical Journal，2023，45（4）：345-347.
[35] 李伟，王清波，马飞飞，等. 支架取栓与血栓直接抽吸技术在急性脑动脉闭塞再通中的疗效比较[J]. 中华脑血管病杂志（电子版），2023，17（2）：102-106.
LI W，WANG Q B，MA F F，et al. Comparative efficacy of stent retriever versus direct aspiration thrombectomy in recanalization of acute cerebral artery occlusion[J]. Chinese Journal of Cerebrovascular Diseases（Electronic Edition），2023，17（2）：102-106.
[36] 简能日，周轩，罗一纯，等. 直接抽吸取栓术与机械支架取栓术在急性颅内血管闭塞中的疗效对比[J]. 中国卒中杂志，2021，16（6）：585-589.
JIAN N R，ZHOU X，LUO Y C，et al. Comparative efficacy of direct aspiration thrombectomy versus mechanical stent thrombectomy in acute intracranial vascular occlusion[J]. Chin J Stroke，2021，16（6）：585-589.
[37] 张敏，黄文国，颜冬润，等. 直接抽吸与支架取栓治疗急性前循环大动脉心源性卒中的效果对比分析[J]. 医药前沿，2022，12（16）：67-69.
ZHANG M，HUANG W G，YAN D R，et al. Comparative analysis of the efficacy between direct aspiration and stent retriever thrombectomy in acute anterior circulation large artery cardioembolic stroke[J]. Medical Frontier，2022，12（16）：67-69.
[38] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e344-e418[2024-10-14]. https://doi.org/10.1161/str.0000000000000211.
[39] ZHANG Y C，ZHANG Y，HU C T，et al. A direct aspiration first-pass technique（ADAPT）versus stent retriever for acute ischemic stroke（AIS）：a systematic review and meta-analysis[J]. J Neurol，2021，268（12）：4594-4606.
[40] CAMPBELL B C V，DONNAN G A，LEES K R，et al. Endovascular stent thrombectomy：the new standard of care for large vessel ischaemic stroke[J]. Lancet Neurol，14（8）：846-854.
[41] SHENG K，TONG M. Aspiration thrombectomy for posterior circulation stroke：a systematic review and meta-analysis[J/OL]. Asian J Neurosurg，2020，15：251-261[2024-10-14]. https://doi.org/10.4103/ajns.ajns_151_19.