Abstract TP304: Safety and efficacy outcomes of Catheter-Assisted Mechanical Thrombectomy versus Catheter-Assisted Aspiration Thrombectomy in Patients with Acute MCA Occlusion Stroke: A Systematic Review and Meta-Analysis

Background: Acute ischemic stroke due to middle cerebral artery (MCA) occlusion remains a leading cause of mortality and long-term disability worldwide. Rapid revascularization is critical to improving neurological outcomes, and endovascular thrombectomy has become the standard of care for large vessel occlusions in the anterior circulation. This Systematic Review and Meta-Analysis aims to evaluate functional recovery, mortality, and safety outcomes of catheter-assisted mechanical thrombectomy with stent retrievers and catheter-assisted aspiration thrombectomy using data from randomized controlled trials (RCTs) and cohort studies. Method: This study followed PRISMA guidelines and the Cochrane Handbook for Systematic Reviews. A comprehensive search of PubMed (MEDLINE), Scopus, EMBASE, and Google Scholar was performed up to July 2025. Continuous variables were analyzed using mean difference (MD) or standardized mean difference (SMD), while categorical outcomes were assessed using odds ratios (OR), all with 95% confidence intervals (CIs). Heterogeneity among studies was evaluated using the I2 statistic and the Chi-square test. Result: A total of 04 retrospective cohorts, 03 prospective cohorts, and 01 randomized controlled trial met the inclusion criteria. No significant difference was observed between catheter-assisted aspiration thrombectomy (CAT) and stent retriever thrombectomy (SR) in 90-day functional independence (RR = 1.14, 95% CI =0.93–1.39) or mortality (RR = 0.97, 95% CI = 0.72–1.31). Rates of symptomatic intracranial hemorrhage were comparable, with CAT showing a nonsignificant trend toward lower risk. CAT achieved significantly faster recanalization (MD = –38 min, p = 0.0008) and shorter procedure times (MD = –27 min, p = 0.028), though heterogeneity was present. First-pass effect, NIHSS improvement, onset-to-groin puncture time, and rescue therapy requirements showed no significant differences. Overall, CAT demonstrated procedural efficiency advantages, while both techniques achieved similar clinical outcomes. Conclusion: Catheter-Assisted Aspiration offers an advantage over stent providers in terms of faster recanalization and shorter procedure times, offering procedural efficiency without compromising patient-centered results. Although both procedures are comparably effective in functional recovery, mortality, and safety outcomes, further trials can improve the strength of evidence for precise outcomes in population subgroups.