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Purpose <p>The impact of distal guide catheter placement on clinical outcomes for endovascular thrombectomy (EVT) in large vessel occlusion (LVO) stroke remains uncertain. This systematic review and meta-analysis aims to evaluate the efficacy and safety of distal versus proximal guide catheter placement for EVT.</p> Methods <p>Following PRISMA guidelines, we systematically searched PubMed, EMBASE, and the Cochrane Library from database inception to June&#xa0;15, 2025 to identify studies that directly compared clinical outcomes of distal versus proximal placement of guide catheter. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using a&#xa0;random-effects model. The study protocol was registered on PROSPERO (CRD42024598147).</p> Results <p>A&#xa0;total of seven observational studies involving 1534 patients were included. Distal position of guide catheter was associated with significantly higher likelihood of first pass effect (OR, 2.16 [95% CI, 1.71–2.74]; <i>P</i> &lt; 0.00001), successful recanalization (OR, 2.37 [95% CI, 1.27–4.42]; <i>P</i> = 0.007), and final mTICI&#xa0;3 (OR, 1.53 [95% CI, 1.16–2.01]; <i>P</i> = 0.002). Symptomatic intracranial hemorrhage was comparable between the two groups (OR, 0.76 [95% CI, 0.38–1.51]; <i>P</i> = 0.43).</p> Conclusion <p>Distal placement of guide catheter appears to be beneficial for EVT in LVO stroke, with improved procedural outcomes than those with proximal position.</p>

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Distal Placement of Guide Catheter Improves Efficacy of Endovascular Thrombectomy in Large Vessel Occlusion Stroke: a Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Xin Jiang,
  • Yanbo Li,
  • Ying Zhang,
  • Jian Wang,
  • Hui Lang,
  • Jian Guo,
  • Li He

摘要

Purpose

The impact of distal guide catheter placement on clinical outcomes for endovascular thrombectomy (EVT) in large vessel occlusion (LVO) stroke remains uncertain. This systematic review and meta-analysis aims to evaluate the efficacy and safety of distal versus proximal guide catheter placement for EVT.

Methods

Following PRISMA guidelines, we systematically searched PubMed, EMBASE, and the Cochrane Library from database inception to June 15, 2025 to identify studies that directly compared clinical outcomes of distal versus proximal placement of guide catheter. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using a random-effects model. The study protocol was registered on PROSPERO (CRD42024598147).

Results

A total of seven observational studies involving 1534 patients were included. Distal position of guide catheter was associated with significantly higher likelihood of first pass effect (OR, 2.16 [95% CI, 1.71–2.74]; P < 0.00001), successful recanalization (OR, 2.37 [95% CI, 1.27–4.42]; P = 0.007), and final mTICI 3 (OR, 1.53 [95% CI, 1.16–2.01]; P = 0.002). Symptomatic intracranial hemorrhage was comparable between the two groups (OR, 0.76 [95% CI, 0.38–1.51]; P = 0.43).

Conclusion

Distal placement of guide catheter appears to be beneficial for EVT in LVO stroke, with improved procedural outcomes than those with proximal position.