Supplementary materials: MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke

These are peer-reviewed supplementary materials for the article 'MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke' published in the Journal of Comparative Effectiveness Research.Supplementary Table 1: Search termsSupplementary Table 2: Studies excluded for potential population selection biasSupplementary Table 3: Study and patient baseline characteristics at the study levelSupplementary Table 4: Combined (EmboTrap, Trevo, and Solitaire) ordinal mRS scores across treatment groups.Supplementary Results 1: Ordinal mRS scores at 90 daysSupplementary Results 2: Core-lab subanalysis:Supplementary Results 3: Prospective-only subanalysis.Supplementary Table 5: Comparison of recanalization outcomes between EmboTrap®, Trevo, and Solitaire among studies with outcomes adjudicated by a core-laboratory.Supplementary Table 6: Comparisons of functional, safety, and recanalization outcomes between EmboTrap®, Trevo, and Solitaire among prospective studies.Supplementary Figure 1: Outlier and influence analyses of rates of mRS 0-2 at 90 daysSupplementary Figure 2: Forest plot of comparisons of mRS 0-2 at 90 days.Supplementary Figure 3: Forest plot of comparisons of mRS 0-2 at 90 days.Supplementary Figure 4: Outlier and influence analyses of rates of mortality at 90 daysSupplementary Figure 5: Forest plot of comparisons of mortality at 90 days.Supplementary Figure 6: Forest plot of comparisons of mortality at 90 daysSupplementary Figure 7: Outlier and influence analyses of ENT ratesSupplementary Figure 8: Forest plot of comparisons of ENT/distal emboli.Supplementary Figure 9: Outlier and influence analyses of sICH rates.Supplementary Figure 10: Forest plot of comparisons of sICH.Supplementary Figure 11: Forest plot of comparisons of complete or near-complete recanalization on first pass (FPR mTICI ≥2c).Supplementary Figure 12: Forest plot of comparisons of successful recanalization on first pass (mFPR mTICI ≥2b).Supplementary Figure 13: Forest plot of comparisons of final complete recanalization (TICI 3).Supplementary Figure 14: Forest plot of comparisons of final successful recanalization (mTICI ≥2b).Supplementary Figure 15: Forest plot of comparisons of complete or near-complete recanalization on first pass (FPR mTICI ≥2c) among core-lab adjudicated studies.Supplementary Figure 16: Forest plot of comparisons of successful recanalization on first pass (mFPR mTICI ≥2b) among core-lab adjudicated studies.Supplementary Figure 17: Forest plot of comparisons of final complete recanalization (TICI 3) among core-lab adjudicated studies.Supplementary Figure 18: Forest plot of comparisons of final successful recanalization (mTICI ≥2b) among core-lab adjudicated studies Supplementary Figure 19: Forest plot of comparisons of successful recanalization on first pass (mFPR mTICI ≥2b) among prospective studies.Supplementary Figure 20: Forest plot of comparisons of final complete recanalization (TICI 3) among prospective studies.Supplementary Figure 21: Forest plot of comparisons of final successful recanalization (mTICI ≥2b) among prospective studies.Supplementary Figure 22: Forest plot of comparisons of ENT/distal emboli among prospective studies.Supplementary Figure 23: Forest plot of comparisons of sICH among prospective studies.Supplementary Figure 24: Forest plot of comparisons of mRS 0-2 at 90 days among prospective studies.Supplementary Figure 25: Forest plot of comparisons of mortality at 90 days among prospective studies.Aim: Stent-retriever (SR) thrombectomy has demonstrated superior outcomes in patients with acute ischemic stroke compared with medical management alone, but differences among SRs remain unexplored. We conducted a Systematic Review/Meta-Analysis to compare outcomes between three SRs: EmboTrap , Solitaire™, and Trevo. Methods: We conducted a PRISMA-compliant Systematic Review among English-language studies published after 2014 in PubMed/MEDLINE that reported SRs in ≥25 patients. Functional and safety outcomes included 90-day modified Rankin scale (mRS 0-2), mortality, symptomatic intracranial hemorrhage (sICH), and embolization to new territory (ENT). Recanalization outcomes included modified thrombolysis in cerebral infarction (mTICI) and first-pass recanalization (FPR). We used a random effects Meta-Analysis to compare outcomes; subgroup and outlier-influencer analysis were performed to explore heterogeneity. Results: Fifty-one articles comprising 9,804 patients were included. EmboTrap had statistically significantly higher rates of mRS 0-2 (57.4%) compared with Trevo (50.0%, p = 0.013) and Solitaire (45.3%, p < 0.001). Compared with Solitaire (20.4%), EmboTrap (11.2%, p < 0.001) and Trevo (14.5%, p = 0.018) had statistically significantly lower mortality. Compared with Solitaire (7.7%), EmboTrap (3.9%, p = 0.028) and Trevo (4.6%, p = 0.049) had statistically significantly lower rates of sICH. There were no significant differences in ENT rates across all three devices (6.0% for EmboTrap, 5.3% for Trevo, and 7.7% for Solitaire, p = 0.518). EmboTrap had numerically higher rates of recanalization; however, no statistically significant differences were found. Conclusion: The results of our Systematic Review/Meta-Analysis suggest that EmboTrap may be associated with significantly improved functional outcomes compared with Solitaire and Trevo. EmboTrap and Trevo may be associated with significantly lower rates of sICH and mortality compared with Solitaire. No significant differences in recanalization and ENT rates were found. These conclusions are tempered by limitations of the analysis including variations in thrombectomy techniques in the field, highlighting the need for multi-arm RCT studies comparing different SR devices to confirm our findings.

本数据集为发表于《比较疗效研究杂志》上的文章《MASTRO I：血栓切除术支架取栓器疗效的荟萃分析和系统评价：比较EmboTrap、Solitaire和Trevo在急性缺血性卒中中的功能、安全性和再通结果》的同行评审补充材料。补充表1：搜索词；补充表2：因潜在人群选择偏差而被排除的研究；补充表3：研究水平和患者基线特征；补充表4：治疗组间EmboTrap、Trevo和Solitaire的合并序贯mRS评分；补充结果1：90天序贯mRS评分；补充结果2：核心实验室亚组分析；补充结果3：仅前瞻性亚组分析；补充表5：在核心实验室裁决结果的研究中，比较EmboTrap®、Trevo和Solitaire之间的再通结果；补充表6：在前瞻性研究中，比较EmboTrap®、Trevo和Solitaire之间的功能、安全性和再通结果；补充图1：90天mRS 0-2率异常值和影响分析；补充图2：90天mRS 0-2率的森林图；补充图3：90天mRS 0-2率的森林图；补充图4：90天死亡率异常值和影响分析；补充图5：90天死亡率的森林图；补充图6：90天死亡率的森林图；补充图7：ENT率异常值和影响分析；补充图8：ENT/远端栓塞的森林图；补充图9：sICH率异常值和影响分析；补充图10：sICH的森林图；补充图11：首次通过完全或近乎完全再通（FPR mTICI ≥2c）的森林图；补充图12：首次通过成功再通（mFPR mTICI ≥2b）的森林图；补充图13：最终完全再通（TICI 3）的森林图；补充图14：最终成功再通（mTICI ≥2b）的森林图；补充图15：在核心实验室裁决的研究中，首次通过完全或近乎完全再通（FPR mTICI ≥2c）的森林图；补充图16：在核心实验室裁决的研究中，首次通过成功再通（mFPR mTICI ≥2b）的森林图；补充图17：在核心实验室裁决的研究中，最终完全再通（TICI 3）的森林图；补充图18：在核心实验室裁决的研究中，最终成功再通（mTICI ≥2b）的森林图；补充图19：仅前瞻性研究中，首次通过成功再通（mFPR mTICI ≥2b）的森林图；补充图20：仅前瞻性研究中，最终完全再通（TICI 3）的森林图；补充图21：仅前瞻性研究中，最终成功再通（mTICI ≥2b）的森林图；补充图22：仅前瞻性研究中，ENT/远端栓塞的森林图；补充图23：仅前瞻性研究中，sICH的森林图；补充图24：仅前瞻性研究中，90天mRS 0-2率的森林图；补充图25：仅前瞻性研究中，90天死亡率的森林图。研究目的：支架取栓器（SR）血栓切除术与单独的药物治疗相比，在急性缺血性卒中患者中显示出更优越的疗效，但不同SR之间的差异尚未得到充分探讨。本研究通过对2014年后的PubMed/MEDLINE英文文献中报道≥25名患者使用SR的系统评价/荟萃分析，对三种SR：EmboTrap、Solitaire™和Trevo的疗效进行了比较。研究方法：本研究按照PRISMA指南进行了系统评价，纳入了2014年后发表的英文文献，并报告了SR的使用。功能和安全结果包括90天改良Rankin量表（mRS 0-2）、死亡率、症状性颅内出血（sICH）和栓塞至新区域（ENT）。再通结果包括改良脑梗死溶栓（mTICI）和首次通过再通（FPR）。我们采用随机效应荟萃分析比较结果；进行亚组和异常值-影响者分析以探索异质性。研究结果：共纳入51篇文章，涉及9,804名患者。与Trevo（50.0%，p = 0.013）和Solitaire（45.3%，p < 0.001）相比，EmboTrap具有显著更高的mRS 0-2率（57.4%）。与Solitaire（20.4%）相比，EmboTrap（11.2%，p < 0.001）和Trevo（14.5%，p = 0.018）具有显著更低的死亡率。与Solitaire（7.7%）相比，EmboTrap（3.9%，p = 0.028）和Trevo（4.6%，p = 0.049）具有显著更低的sICH率。所有三种设备在ENT率方面均无显著差异（EmboTrap为6.0%，Trevo为5.3%，Solitaire为7.7%，p = 0.518）。EmboTrap的再通率数值上更高，但未发现统计学上的显著差异。结论：我们的系统评价/荟萃分析结果表明，与Solitaire和Trevo相比，EmboTrap可能显著改善了功能预后。与Solitaire相比，EmboTrap和Trevo可能与sICH和死亡率的显著降低相关。在再通和ENT率方面未发现显著差异。然而，由于血栓切除术技术的现场变化等分析局限，这些结论应持谨慎态度，并强调需要进行多臂随机对照试验以比较不同SR设备，以证实我们的发现。