title: Functional outcomes and recanalization rates of stent retrievers in acute ischaemic stroke: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Intra-arterial therapy for acute ischaemic stroke has evolved rapidly in the last few years. Stent retrievers have now replaced 'first-generation' devices, which have been the principle devices tested in stroke trials.Our aims were to determine the rates of successful recanalization and functional independence in acute stroke patients treated with stent retrievers. We also sought to assess the safety outcomes of stent retrievers by assessing the rates of mortality and intra-cranial haemorrhage.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of studies which utilized stent retrievers as sole treatment or as part of a multi-modal approach in acute ischaemic stroke.
  
  
  RESULTS
  We identified 20 eligible studies: 17 on Solitaire (ev3/Covidien, Irvine, California, USA) (n = 762) and three on Trevo (Stryker, Kalamazoo, Michigan, USA) (n = 210). The mean age of participants was 66.8 (range 62.1-73.0) years and the M:F ratio was 1.1:1. The average stroke severity score (National Institutes of Health Stroke Scale (NIHSS)) at presentation was 17.2. The weighted mean symptom onset to arterial puncture and procedural duration were 265.4 minutes and 54.8 minutes, respectively.Successful recanalization was achieved in 84.5% of patients with a weighted mean of 2.0 stent retriever passes. Independent functional outcome was achieved in 51.2% and the mortality rate was 16.8%.
  
  
  CONCLUSIONS
  Stent retrievers have the potential to achieve a high rate of recanalization and functional independence whilst being relatively safe. They should be assessed in well-designed randomized controlled trials to determine their efficacy and assess whether they compare favourably with 'standard treatment' in stroke.
authors.affiliation: Medical Imaging Department, Mater Dei Hospital, Msida, Malta reubengrech@yahoo.com.
authors.forename: Reuben
authors.initials: R
authors.lastname: Grech
authors.affiliation: Medical Imaging Department, Mater Dei Hospital, Msida, Malta.
authors.forename: Adrian
authors.initials: A
authors.lastname: Mizzi
authors.affiliation: Medical Imaging Department, Mater Dei Hospital, Msida, Malta.
authors.forename: Richard
authors.initials: R
authors.lastname: Pullicino
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Thornton
authors.affiliation: Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Downer
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000401:mortality / Q000601:surgery; D015984:Causality; D002548:Cerebral Revascularization / Q000295:instrumentation* / Q000379:methods / Q000401:mortality*; D015897:Comorbidity; D020878:Device Removal / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation* / Q000379:methods / Q000401:mortality*; D008875:Middle Aged; D015995:Prevalence; D020127:Recovery of Function; D012086:Reoperation / Q000401:mortality; D018570:Risk Assessment; D020521:Stroke / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Stroke; intra-arterial stroke therapy; mechanical thrombectomy