Double stent-retriever technique for mechanical thrombectomy: a systematic review and meta-analysis

BACKGROUND: Mechanical thrombectomy using a double stent-retriever technique has recently been described for the treatment of acute ischemic stroke, but its efficacy and safety are not well established.

PURPOSE: The aim of this systematic review and meta-analysis was to evaluate reports of the use of double stent-retriever during the endovascular treatment of patients with ischemic stroke.

DATA SOURCES: The PubMed, Embase, Web of Science and Scopus databases were searched to identify all studies (clinical trials, cohorts series and case reports) investigating the utility of double stent-retriever for the treatment of stroke. The study is reported in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (BLINDED FOR PEER REVIEW).

STUDY SELECTION: 17 studies involving a total of 128 patients with large vessel occlusions predominantly in the anterior circulation (93.0%) were identified.

DATA ANALYSIS: Outcomes of interest were the prevalence of successful recanalization (mTICI ≥2b) and a first-pass effect following double stent-retriever, as well as complications such as iatrogenic dissections and subarachnoid hemorrhage. Data were pooled using a random-effects model.

DATA SYNTHESIS: Double stent-retriever was used as a rescue strategy in occlusions refractory to conventional endovascular treatment in 68.7% (88/128) of patients and as a first-line strategy in 31.3% (40/128) patients. Double stent-retriever achieved an overall final mTICI ≥2b in 92.6% cases with a first-pass effect of 76.6%. The complication rate remained low, with 0.37% dissection and 1.56% subarachnoid hemorrhage.

LIMITATIONS: Limitations of the study include (1) a large number of case reports or small series, (2) a meta-analysis of proportions with no statistical comparison to a control group, and (3) the lack of access to patient-level data.

CONCLUSIONS: Our findings suggest that double stent-retriever thrombectomy may be safe and associated with good recanalization outcomes, but prospective comparative studies are needed to determine which patients may benefit from this endovascular procedure.

ABBREVIATIONS: AICH = asymptomatic intracranial hemorrhage; AIS = acute ischemic stroke; DSR = double stent-retriever; FPE = first pass effect; ICH = intracranial hemorrhage; LVO = large vessel occlusion; MT = mechanical thrombectomy; SAH = subarachnoid hemorrhage; SICH = symptomatic intracranial hemorrhage; SSR = single stent-retriever.