Distal versus proximal guide catheter placement on the safety and efficacy of mechanical thrombectomy for acute ischemic stroke in anterior circulation: A systematic review and meta-analysis.
Trey Seymour, Sherief Ghozy, Seyed Behnam Jazayeri et al.
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In 30 seconds
This systematic review and meta-analysis pooled seven retrospective comparative studies of 2,148 adults undergoing mechanical thrombectomy for anterior-circulation large-vessel-occlusion stroke. Compared with proximal guide-catheter placement, distal placement was associated with higher functional independence at 90 days (risk ratio [RR] 1.25, 95% CI 1.10-1.42), alongside better reperfusion and first-pass recanalization and shorter procedure time. The analysis found no significant difference in symptomatic intracranial haemorrhage or emboli to a new territory. The authors regard the findings as preliminary because the evidence is retrospective and study methods and outcome definitions varied.
Key findings
- Distal placement was associated with greater 90-day functional independence (RR: 1.25, 95% CI: 1.10-1.42).
- Successful reperfusion and first-pass recanalization were more frequent with distal placement (RR: 1.13, 95% CI: 1.04-1.22; RR: 1.35, 95% CI: 1.15-1.58).
- Puncture-to-recanalization time was shorter with distal placement (mean difference: -7.7 min, 95% CI: -10.8 to -4.6).
- No significant differences were observed in symptomatic intracranial haemorrhage or emboli to a new territory.
Why it matters
Guide-catheter position is a procedural choice that may relate to thrombectomy efficiency and patient outcomes. These pooled findings suggest distal placement could be associated with better reperfusion and functional outcomes without a detected increase in the reported complications. However, the retrospective evidence cannot establish that catheter position itself accounts for the differences, so the results should inform evaluation rather than be treated as definitive.
What to keep in mind
All seven included studies were retrospective. The authors note potential anatomic confounding, variation in techniques and outcome definitions, and that publication bias could not be excluded.