Technical success and early outcomes of mechanical thrombectomy and thrombo-aspiration for acute limb ischemia: a systematic review and meta-analysis

INTRODUCTION: In recent years, thrombo-aspiration (TA) and mechanical thrombectomy (MT) have emerged as endovascular alternatives to conventional treatments such as surgical thrombectomy or catheter-directed thrombolysis (CDT) for acute limb ischemia (ALI). To date, no meta-analysis has assessed the outcomes of TA and MT in this setting. This study aims to evaluate the short-term safety and effectiveness of these techniques in patients with ALI. EVIDENCE ACQUISITION: Systematic searches on studies evaluating the safety and efficacy of TA or MT in ALI were conducted in PubMed/Medline and Cochrane Central from 2010 to 2023. The meta-analysis followed PRISMA guidelines. The primary endpoint was amputation rate at 30 days. Secondary endpoints included 30-day mortality, technical success alone, and success with adjuvant treatment (angioplasty, stenting, CDT). EVIDENCE SYNTHESIS: A total of 591 articles were screened, and 10 studies (1083 patients, 1092 limbs) were included. The pooled one-month major amputation rate was 5% [95% CI: 1-8%]. In subgroup analysis, the amputation rate was 0% [95% CI: 0-1%] for TA and 8% [95% CI: 4-13%] for MT, reflecting differences in patient severity profiles. One-month mortality was 3% [95% CI: 1-5%]. Technical success alone was 57% [95% CI: 39-75%] overall, with a marked difference between TA (73% [95% CI: 54-93%]) and MT (48% [95% CI: 16-80%]). Assisted technical success reached 97% [95% CI: 94-100%]. CONCLUSIONS: Short-term outcomes of TA and MT suggest these techniques are promising for ALI treatment. However, their effectiveness relies heavily on adjunctive therapies, especially for MT. Future randomized trials and cost-effectiveness analyses with long-term follow-up are needed to define the true value of these approaches.