The metaanalysis was performed using revman software, version. A metaanalysis of randomized trials including surrogate and clinical outcomes prior to the publication of two large multicenter studies. Study included in this metaanalysis must meet the following criteria. However, a meta analysis of the more recent larger randomized trials demonstrated that aspiration thrombectomy in stemi has failed to demonstrate any benefits in clinical outcomes, table 3trials. Firstline contact aspiration vs stentretriever thrombectomy in acute ischemic stroke patients with largeartery occlusion in the anterior circulation. The angiojet thrombectomy system is a pharmacomechanical peripheral thrombectomy device with active aspiration and power pulse lytic delivery designed to treat the widest range of thrombosed vessels, rapidly restoring blood flow. Sep 24, 2016 the fourth option, mechanical aspiration sheath thrombectomy mast, is a technique developed by dan clair, our former chair. In addition, studies comparing the firstline combined approach to either stent retriever or direct aspiration thrombectomy are needed to increase statistical power in future analyses. Safety and efficacy of solitaire stent thrombectomy. Jan 21, 2011 comparison of manual aspiration with rheolytic thrombectomy in patients undergoing primary pci. Outcomes of stent retriever versus aspirationfirst thrombectomy. Texakalidis p1, giannopoulos s2, karasavvidis t3, rangelcastilla l4, rivet dj5, reaveycantwell j5. Shortly thereafter, the american college of cardiology and american heart association updated their.
Five studies investigated aspiration thrombectomy only, and 16 studies investigated adapt. One of these studies was prospective, and the rest were retrospective. The fourth option, mechanical aspiration sheath thrombectomy mast, is a technique developed by dan clair, our former chair. In an elegant metaanalysis published 5 years ago, bavry et al. Objectives this metaanalysis was designed to update data on clinical outcomes with aspiration thrombectomy or mechanical thrombectomy before primary percutaneous coronary intervention pci compared with conventional primary pci alone. Several randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available.
Thrombectomy 6 to 24 hours after stroke among patients with occlusion of a large intracerebral vessel who had a clinical deficit that was disproportionately severe relative to the infarct volume, 9. We conducted a meta analysis to assess the angiographic and clinical outcomes for ischemic stroke patients treated with primary suction thrombectomy and to compare the procedural outcomes based on the treatment strategies primary suction vs. There was no difference between stent retriever and thrombo aspiration thrombectomy on subgroup analysis in both clinical outcome and safety profile. The primary outcomes were successful reperfusion defined by expanded tici grades 2b3 at the end of all. Performing manual aspiration thrombectomy during primary percutaneous coronary intervention pci reduces major adverse cardiac events mace including mortality, but the same benefit is not seen with mechanical thrombectomy, according to a large metaanalysis scheduled. Aspiration thrombectomy for treatment of stsegment elevation. Coding aspiration thrombectomy cardiology coding ask an. Thrombectomy 6 to 24 hours after stroke with a mismatch. The role of manual aspiration thrombectomy in patients. Subgroup analysis in taste and total did not identify any. One striking finding our metaanalysis revealed is a lack of standardization in the reporting of outcomes following mechanical thrombectomy. Metaanalyses were also done for the secondary outcomes of recanalization and symptomatic haemorrhage.
Hence, aspiration thrombectomy was designed as an adjunctive tool to aid in the restoration of the coronary blood flow. The angiojet ultra thrombectomy system is a mechanical thrombectomy device for pci patients with large thrombus burden, for removal of thrombus in native coronary arteries and saphenous vein bypass grafts. Thrombectomy and embolectomy are lifesaving procedures mostly performed in emergency situations. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. Primary suction thrombectomy for acute ischemic stroke. A more recent meta analysis including 26 rcts, reported a. A collaborative sequential meta analysis of individual patient data from randomized trials of endovascular therapy and tpa vs. Those findings echo those of the large total trial, published last year.
Thrombectomy system market global industry analysis, size. Intracoronary ic glycoprotein iibiiia inhibitors gpis after thrombus aspiration ta for patients with stsegment elevation myocardial infarction stemi, as compared with percutaneous coronary interventions pci alone, is still on debate. Our metaanalysis of data from 5,534 patients with ami in 25 trials indicates that as compared with conventional primary pci alone, aspiration thrombectomy was associated with a significant 24% reduction in mace, including a 29% reduction in allcause mortality at 6 months median followup. There is no consensus on endovascular treatment for terminal ica.
Powerful aspiration and superior kink resistance large extraction lumen yielding better aspiration otw system avoiding vessel wall damage side aspiration. Role of aspiration and mechanical thrombectomy in patients. We performed the statistical analysis using stata software version 14. Comparison of the efficacy and safety of thrombectomy devices. On propensity analysis, there was no difference in 1year mortality between any form of thrombectomy versus conventional pci, including adjunctive aspiration thrombectomy and conventional pci n 85,675. The terms embolectomy and thrombectomy are sometimes used interchangeably, but there are some differences between the two. These 3 more recent trials, as well as an updated metaanalysis, found no significant reduction in adverse events with routine aspiration thrombectomy. Comparison of the efficacy and safety of thrombectomy. Our analysis of 30 randomized trials in 6415 patients with acute myocardial infarction shows that thrombectomy devices produce heterogeneous clinical outcomes depending on the type of the device used. Metaanalysis of clinical outcomes at maximum followup. Methods clinical trials that randomized ami patients. Statistical analyses were performed with revman software, version 5. Routine aspiration thrombectomy prior to primary pci was not associated with a.
This channel includes news and new technology innovations for catheterbased thrombectomy systems used to remove blood clots from vessels in the body. Aspiration thrombectomy prior to percutaneous coronary. Mechanical thrombectomy for acute ischemic stroke in. Ivt is the standard of care for acute ischemic stroke. We conducted a retrospective analysis of patients with terminal. Aspiration thrombectomy at prevents thromboembolic events by mechanical. In a bayesian meta analysis, including 21 trials 16 that used a simple aspiration thrombectomy device, mongeon et al. To minimize the case bias, propensity score matching was performed. Background the clinical efficacy of thrombectomy in acute myocardial infarction ami remains uncertain. Review of the dawn trial pouya tahsilifahadan, md nogueira rg, jadhav ap, haussen dc, bonafe a, budzik rf, bhuva p, et al. We conducted a network metaanalysis nma that enables comparison of modern mt devices trevo, solitaire, aspiration and strategies stent retriever vs.
Thrombus removal a decade ago was a standard of care for acute coronary revascularization in stelevation myocardial infarction stemi. There was no difference between stent retriever and thromboaspiration thrombectomy on subgroup analysis in both clinical outcome and safety profile. The sheath is then removed and the contents emptied. Our meta analysis of data from 5,534 patients with ami in 25 trials indicates that as compared with conventional primary pci alone, aspiration thrombectomy was associated with a significant 24% reduction in mace, including a 29% reduction in allcause mortality at 6 months median followup. A recent meta analysis of 20 rcts addressing patientimportant outcomes and including over 11,000 patients reported that aspiration thrombectomy prior to primary pci was associated with a reduction in major coronary adverse events and 1year mortality. Review manager revman provided the software for all analyses. Longterm outcomes with aspiration thrombectomy for. Intracoronary glycoprotein iibiiia inhibitors improve.
It usually involves removal of thrombi blood clots, and is then referred to as thrombectomy. With rapid technological advancement, increase in the number of aging population and increase in demand for minimally invasive surgery, the thrombectomy system global market is expected to have healthy growth rate in the forecast period 20122025. To address this issue, we performed a metaanalysis of results from prospective or randomized controlled trials on the topic. Firstline contact aspiration vs stentretriever thrombectomy. The smartpci trial smart the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Therefore, therapies achieving the highest recanalization rates within the shortest period of time are likely to yield the best clinical outcomes. Introduction mechanical thrombectomy mt is increasingly used for largevessel occlusions lvo, but randomized clinical trial rct level data with regard to differences in clinical outcomes of mt devices are limited. A stent retriever was used as the firstline thrombectomy device in 337 patients 48.
We conducted a network meta analysis nma that enables comparison of modern mt devices trevo, solitaire, aspiration and strategies stent retriever vs aspiration across. A large meta analysis confirms there is no clinical benefit with routine aspiration thrombectomy in primary pci and points to a possible increase in the risk of stroke. Devices were grouped into catheter thrombus aspiration, mechanical. There is continued debate about the routine use of aspiration thrombectomy in. We performed a metaanalysis of the larger 150 patients rcts that compared at. Data and publication bias were visualized with forest plots and funnel plots. Recanalization is the strongest predictor of outcome after acute occlusion of large intracranial arteries. The system is designed to mechanically restore blood flow of patients with thrombosed arteries. A recent metaanalysis of 20 rcts addressing patientimportant outcomes and including over 11,000 patients reported that aspiration thrombectomy prior to primary pci was associated with a reduction in major coronary adverse events and 1year mortality. Metaanalysis was performed by using a random effects model. Neither of these meta analyses included the recently published trial of routine aspiration thrombectomy with pci versus pci alone in patients with stemi total, which randomized over 10,000 patients. Powerful aspiration and superior kink resistance large extraction lumen yielding better aspiration otw. Primary percutaneous coronary intervention medscape. Endovascular thrombectomy after largevessel ischaemic stroke.
To understand how a thrombectomy or embolectomy is performed, you must first understand why they are done. Furthermore, many patients with large or proximal clots may not achieve adequate reperfusion with thrombolysis, and treatment carries the risk of intracranial haemorrhage, which can be fatal. Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty. Embolectomy is the emergency surgical removal of emboli which are blocking blood circulation. We conducted a retrospective analysis of patients with terminal ica occlusion treated with aspiration thrombectomy or stent retriever thrombectomy in our center, from september 20 to november 2018. For patients with acute ischemic stroke ais, the thrombus density on nonenhanced ct nect indicates the composition of the thrombus, a characteristic that impacts the efficacy of mechanical thrombectomy mt. May 17, 20 performing manual aspiration thrombectomy during primary percutaneous coronary intervention pci reduces major adverse cardiac events mace including mortality, but the same benefit is not seen with mechanical thrombectomy, according to a large meta analysis scheduled. Is aspiration thrombectomy beneficial in patients undergoing. Trials of aspiration thrombectomy at prior to primary. Thrombus aspiration in stsegmentelevation myocardial. Mechanical thrombectomy in basilar artery occlusion. Study included in this meta analysis must meet the following criteria. Jan 24, 2020 study included in this metaanalysis must meet the following criteria. A more recent metaanalysis including 26 rcts, reported a.
A previous meta analysis suggested a correlation between higher thrombus density and successful reperfusion, but some new studies have drawn different conclusions. Frontiers association between thrombus density and. Meta analyses were also done for the secondary outcomes of recanalization and symptomatic haemorrhage. Goyal m, menon b, van zwam w et al, for the hermes collaborators. Using data from 30 studies of 6,415 patients, they found. Apr, 2017 hence, aspiration thrombectomy was designed as an adjunctive tool to aid in the restoration of the coronary blood flow. Meta analysis of clinical outcomes at maximum followup. A recent metaanalysis of 20 rcts addressing patientimportant outcomes and including over 11,000 patients reported that aspiration thrombectomy prior to primary pci was associated with a reduction in major coronary adverse events and 1year mortality 4.
Comparison of aspiration versus stent retriever thrombectomy. A recent meta analysis of 20 rcts addressing patientimportant outcomes and including over 11,000 patients reported that aspiration thrombectomy prior to primary pci was associated with a reduction in major coronary adverse events and 1year mortality 4. The 20 guidelines state, nonmechanical, aspiration thrombectomy is not reported with 92973, and is included in the pci code for acute myocardial infarction 92941, when performed. Metaanalysis comparing aspiration pci versus conventional pci on overall mortality.
A collaborative sequential metaanalysis of individual patient data from randomized trials of endovascular therapy and tpa vs. Adjunctive thrombectomy for acute myocardial infarction a. Nov 12, 2017 braided radioopaque aspiration catheter. We conducted a metaanalysis to assess the angiographic and clinical outcomes for ischemic stroke patients treated with primary suction thrombectomy and to compare the procedural outcomes based on the treatment strategies primary suction vs. A meta analysis of stent retrievers vs direct aspiration vs a combined approach. The use and utility of aspiration thrombectomy in acute. The purpose of this study was to evaluate the comparative safety and efficacy of preferred aspiration thrombectomy and stent retriever thrombectomy for revascularization in patients with isolated terminal ica occlusion. A recent metaanalysis of 20 rcts addressing patientimportant outcomes and. Objectives this meta analysis was designed to update data on clinical outcomes with aspiration thrombectomy or mechanical thrombectomy before primary percutaneous coronary intervention pci compared with conventional primary pci alone. Mechanical aspiration sheath thrombectomy a surgeons notes.
We performed a metaanalysis of 26 randomized controlled trials with a total of 11. Comparison of manual aspiration with rheolytic thrombectomy. All analyses were performed using stata software v9. They included 98,176 stemi patients undergoing primary pci from the u. Role of adjunctive thrombectomy and embolic protection. A recent metaanalysis of 20 rcts addressing patientimportant outcomes. Thus, new mechanical thrombectomy mt strategies, including a directaspiration firstpass technique adapt, remain to be evaluated in basilar artery occlusion bao patients. Conclusion the present metaanalysis suggested that there was no. A large metaanalysis confirms there is no clinical benefit with routine aspiration thrombectomy in primary pci and points to a possible increase in the risk of stroke. In a recent meta analysis of stent retriever thrombectomy in bao, which pooled the event rates for mortality in 15 observational series, the mortality rates were highly variable among all studies ranging from 6% to 46%. Outcomes of stent retriever versus aspirationfirst thrombectomy in ischemic.
Thrombus aspiration in stsegmentelevation myocardial infarction. Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to an organ leads to necrosis. How often should aspiration thrombectomy be performed in. Adjunctive thrombectomy for acute myocardial infarction a bayesian metaanalysis article in circulation cardiovascular interventions 31. However, a metaanalysis of the more recent larger randomized trials demonstrated that aspiration thrombectomy in stemi has failed to demonstrate any benefits in clinical outcomes, table 3trials. In a bayesian metaanalysis, including 21 trials 16 that used a simple aspiration thrombectomy device, mongeon et al. A previous metaanalysis suggested a correlation between higher thrombus density and successful reperfusion, but some new studies have drawn different. In our study, we observed mortality rate of 8% in pc group. But, its use declined rapidly after several large trials showed no benefit. Jul 17, 2019 in addition, studies comparing the firstline combined approach to either stent retriever or direct aspiration thrombectomy are needed to increase statistical power in future analyses.
A more recent meta analysis including 26 rcts, reported a different conclusion. Efficacy and safety of routine aspiration thrombectomy during. In the metaanalysis, 696 patients were eligible for analysis, including 368 men, and 328 women with mean age ranging from 64. Cather thrombus aspiration for example, export and pronto prior to pci significantly reduces mortality, compared with pci alone. Trials of aspiration thrombectomy at prior to primary percutaneous. A large sheath 12f is introduced and the thrombus is aspirated while the bare sheath is advanced over a wire. Adjunctive manual thrombus aspiration during stsegment. Longterm outcomes with aspiration thrombectomy for patients. A study was considered eligible if it was a published rct that compared efficacy and safety outcomes of acute ischemic stroke managed with. Meta analysis was performed by using a random effects model. The objective of this metaanalysis was to compare the safety and effectiveness of cdt with surgical revascularization in the initial management of ali, and to evaluate the various. One striking finding our meta analysis revealed is a lack of standardization in the reporting of outcomes following mechanical thrombectomy. In this metaanalysis, we, the trial investigators, aimed to pool the individual patient data from these trials to determine the benefits and risks of thrombus aspiration during pci in patients with stsegmentelevation myocardial infarction. Role of adjunctive thrombectomy and embolic protection devices in.
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