{
  "abstract": "Background Direct aspiration (ADAPT), stent retriever (SR), and primary combined approach (PCA) are widely used first-line thrombectomy strategies. In large vessel occlusion (LVO), these techniques demonstrate comparable clinical outcomes. However, in medium vessel occlusion (MeVO), where vessel caliber and tortuosity increase technical complexity, direct comparisons of these strategies remain limited. We performed a network meta-analysis to compare the efficacy, safety, and procedural efficiency of ADAPT, SR, and PCA in MeVO thrombectomy.Methods A network meta-analysis of 10 studies was conducted comparing ADAPT, SR, and PCA. Outcomes included 90-day functional independence (mRS 0-2), good recanalization (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), 90-day mortality, first-pass effect, and procedural duration. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Consistency between direct and indirect evidence was assessed, and treatment ranking was performed.Results There were no significant differences across strategies in 90-day functional independence (PCA vs ADAPT: OR 0.89, 95% CI 0.56-1.40; SR vs ADAPT: OR 1.24, 95% CI 0.76-2.03) or good re-canalization (PCA: OR 1.17, 95% CI 0.59-2.35; SR: OR 1.04, 95% CI 0.50-2.17). Similarly, rates of sICH (PCA: OR 1.68, 95% CI 0.65-4.30; SR: OR 0.91, 95% CI 0.36-2.34), 90-day mortality (PCA: OR 1.21, 95% CI 0.58-2.53; SR: OR 0.66, 95% CI 0.28-1.55), and first-pass effect (PCA: OR 0.74, 95% CI 0.42-1.31; SR: OR 0.97, 95% CI 0.46-2.05) were comparable. In contrast, procedural duration was significantly shorter with ADAPT compared with PCA (MD −11.77 minutes, 95% CI −17.74 to −5.80) and SR (MD −8.32 minutes, 95% CI −14.93 to −1.71), with no difference between PCA and SR (MD −3.45 minutes, 95% CI −10.74 to 3.84). Treatment ranking favored ADAPT as the most efficient strategy, followed by SR and PCA.Conclusion In MeVO thrombectomy, ADAPT, SR, and PCA demonstrate comparable efficacy and safety. However, ADAPT is associated with significantly shorter procedural duration, suggesting a potential efficiency advantage without compromising clinical outcomes. Further prospective head-to-head studies are needed to validate these findings and define optimal first-line strategy selection.Disclosures M. Jatty: None. K. Muthiah: None. P. Pitchan Velammal: None.Abstract E-231 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurology, University of Tennessee health science center, Memphis, TN"
      ],
      "name": "M Jatty"
    },
    {
      "affiliations": [
        "Neurology, University of Tennessee health science center, Memphis, TN"
      ],
      "name": "K Muthiah"
    },
    {
      "affiliations": [
        "Neurology, University of Tennessee health science center, Memphis, TN"
      ],
      "name": "P Pitchan Velammal"
    },
    {
      "affiliations": [
        "Neurosurgery, Semmes-Murphey Clinic, Memphis, TN"
      ],
      "name": "C Nickele"
    },
    {
      "affiliations": [
        "Neurology, University of Tennessee health science center, Memphis, TN"
      ],
      "name": "N Goyal"
    }
  ],
  "title": "E-231 Efficiency without compromise: a network meta-analysis of first-line thrombectomy strategies in medium vessel occlusion stroke",
  "uid": "3490fdd1-28f7-5007-b29e-2899916b4dc6"
}