Delivery-assist catheters in mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis

BACKGROUND: Acute ischemic stroke due to large-vessel or medium-vessel occlusion is often treated with aspiration thrombectomy. Delivery-assist catheters (DAsCs) are a new class of tapered support catheters designed to facilitate navigation of large-bore aspiration catheters through tortuous anatomy. OBJECTIVE: To perform a meta-analysis to evaluate the procedural efficacy and safety of DAsC-assisted aspiration thrombectomy. METHODS: A PRISMA-guided systematic review identified studies using DAsCs during aspiration thrombectomy for large- or medium-vessel occlusions. We extracted data on successful reperfusion; first pass effect (FPE), defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b (FPE≥2b) and mTICI≥2c (FPE≥2); use of adjunctive devices; and symptomatic intracranial hemorrhage (sICH). Pooled event rates with 95% CIs were calculated using a random-effects meta-analysis of proportions. RESULTS: 14 studies were identified with 720 patients. Pooled successful reperfusion was 95% (95% CI 91 to 97%) for final mTICI ≥2b and 71% (95% CI 59% to 81%) for final mTICI ≥2c. FPE ≥2c was achieved in 51% (95% CI 43% to 59%) of cases, while FPE ≥2b was 65% (95% CI 54% to 75%). Adjunctive rescue devices were used in 23% (95% CI 17% to 30%) of procedures. Puncture-to-recanalization time was 26.1 min on average. The rate of sICH was 1% (95% CI 0% to 3%), and 44% (95% CI 39% to 50%) of patients had a 90-day modified Rankin Scale score of 0-2. CONCLUSIONS: In pooled analysis, DAsC-assisted aspiration thrombectomy demonstrated high first pass efficacy and low hemorrhagic rates across single-arm studies. This meta-analysis supports DAsCs as a safe adjunct to aspiration thrombectomy. Prospective comparative studies are warranted to evaluate technical performance and safety relative to standard aspiration techniques.