• Giovanni Barchetti, Federico Cagnazzo, Eytan Raz, Giuseppe Barbagallo, Giada Toccaceli, and Simone Peschillo.
• Interventional Neuroradiology, Sapienza University of Rome, Rome, Italy.
• World Neurosurg. 2020 Feb 1; 134: 111-119.

BackgroundThere are no current evidence-based recommendations on mechanical thrombectomy (MT) in M2 or other distal occlusions. The objective of this paper was to investigate clinical and radiologic outcomes of MT in distal locations using the new generation of mini-0.017 microcatheter compatible-stent retrievers (SRs) compared with a direct aspiration first pass technique (ADAPT) MT.MethodsA systematic search was performed for studies published from January 2016 to March 2019. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies that reported clinical and radiologic outcomes of patients undergoing MT using new generation of SRs or ADAPT in distal locations. The cumulative prevalence was estimated for each outcome. Heterogeneity of the data was assessed by the Higgins index (I2), and a random-effects model was applied.ResultsFifteen studies and 494 patients were included; 7 studies reported on patients treated with a new SR and 8 studies analyzed patients treated with ADAPT. The rate of thrombolysis in cerebral infarction score 2b-3 after MT for distal occlusions was 80.6% (383 of 494; 95% confidence interval [CI], 74.8%-86.3%; I2 = 64.4%). Successful recanalization was comparable after SR use with low-profile devices and ADAPT (176 of 226; 82%; 95% CI, 72.6%-1.5%; I2 = 70.5% vs. 207 of 268; 79.4%; 95% CI, 71.8%-86.9%; I2 = 60.8%, respectively; P = 0.4). The rate of the modified Rankin scale score of 0-2 at 3 months was higher in the ADAPT group (160 of 251; 68.9%; 95% CI, 51.8%-85.9%; I2 = 92.2%) than the SR group (92 of 177; 58.7%; 95% CI, 37.3%-80%; I2 = 58.7%; P = 0.01). The mortality rate was lower among the ADAPT group (20 of 251; 5.4%; 95% CI, 1.4%-9%; I2 = 63%) than the SR group (16 of 108; 13%; 95% CI, 6%-19%; I2 = 13%; P = 0.008).ConclusionsMT in distal locations using the new generation of SR yields comparable results compared with ADAPT in terms of recanalization; however, the use of SR is associated with lower functional independence and higher mortality rate.Copyright © 2019 Elsevier Inc. All rights reserved.

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