A Meta-analysis of Combined Aspiration Catheter and Stent Retriever versus Stent Retriever Alone for Large-Vessel Occlusion Ischemic Stroke

Schartz, Derrek; Ellens, Nathaniel R; Kohli, Gurkirat; Akkipeddi, Sajal Medha K; Colby, Geoffrey P.; Bhalla, Tarun; Mattingly, Thomas; Bender, Matthew T.

doi:10.3174/ajnr.a7459

Cited by 18 publications

(14 citation statements)

References 26 publications

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“…Therefore, the two first-line thrombectomy techniques seemed to have a similar clinical impact in patients with acute LVO. A recent meta-analysis reported that SR+CA first-line could lead to higher odds of a first-pass effect than SR first-line alone, but similar final recanalisation and functional independence were found between the two groups 25. However, the cost-effectiveness of the entire thrombectomy technique was still known.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Huo¹,

Sun²,

Hu³

et al. 2023

Stroke Vasc Neurol

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Background and purposeAn analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion (LVO) stroke between stent retrieval (SR) alone as a first-line mechanical thrombectomy (MT) technique (SR alone first-line) and concomitant use of contact aspiration (CA) plus SR as a first-line MT technique (SR+CA first-line). The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.MethodsWe conducted the present study by using the data from the ANGEL-ACT registry. We divided the selected patients into SR+CA first-line and SR alone first-line groups. We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes, including successful/complete recanalisation after the first technique alone and all procedures, first-pass successful/complete recanalisation, number of passes, 90-day modified Rankin Scale, procedure duration, rescue treatment and intracranial haemorrhage within 24 hours.ResultsOf the 1233 enrolled patients, 1069 (86.7%) received SR alone first-line, and 164 (13.3%) received SR+CA first-line. SR+CA first-line was associated with more thrombectomy passes (3 (2–4) vs 2 (1–2); β=1.77, 95% CI=1.55 to 1.99, p<0.001), and longer procedure duration (86 (60–129) min vs 80 (50–122) min; β=10.76, 95% CI=1.08 to 20.43, p=0.029) than SR alone first-line group. Other outcomes were comparable (all p>0.05) between the two groups.ConclusionsPatients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line. Additionally, we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level, first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

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Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Huo¹,

Sun²,

Hu³

et al. 2023

Stroke Vasc Neurol

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“…While cases of primary combined stent retriever and aspiration thrombectomy were not included within the presented analysis, a prior study by Perez-Garcia et al studied 238 patients with a combined technique and found that an ID of 0.068 inch facilitated superior FPE and final recanalization with lower complications compared with 0.06/0.054 inch aspiration catheters 34. This is a relevant consideration given mounting evidence that a combined approach may result in superior FPE compared with direct stent retriever thrombectomy alone 35. If the goal is to maximize FPE, it seems that choosing to use a stent retriever does not license the interventionalist to select a smaller more trackable aspiration catheter.…”

Section: Discussionmentioning

confidence: 99%

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

Schartz

Ellens²,

Kohli³

et al. 2022

J NeuroIntervent Surg

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BackgroundDirect aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood.MethodsA systematic literature review and meta-regression analysis was completed to evaluate the impact of primary aspiration thrombectomy outcomes based on the ID of the aspiration catheter. Primary outcome measures were: final recanalization of modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3 with aspiration only and with rescue modalities, first pass effect (FPE), need for rescue modalities, intracranial hemorrhagic complication rates, and functional outcomes of 90-day modified Rankin Scale (mRS) of 0–2.Results30 studies were identified with 3228 patients. Meta-regression analysis revealed a significant association between increasing aspiration catheter ID and FPE (p=0.032), between ID and final recanalization with aspiration only (p=0.05), and between ID size and recanalization including cases with rescue modalities (p=0.002). Further, subgroup analysis indicated that catheters with an ID ≥0.064 inch had a lower rate of need for rescue than smaller catheters (p=0.013). Additionally, catheters with an ID ≥0.068 inch had a higher rate of intracranial bleeding complications (p=0.025). Lastly, no significant association was found in functional outcomes overall.ConclusionsLarger aspiration catheters are associated with a higher rate of FPE, final recanalization with only an aspiration catheter, and in cases with rescue modalities, though with a higher rate of hemorrhagic complications. These findings confirm that aspiration catheter size functions as a variable in aspiration thrombectomy, which should be considered in future study and trial design.

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“…The ASTER2 trial failed to show a technical and clinical superiority of first-line CoT compared with first-line SR at the end of the endovascular procedure although a significantly higher rate of successful recanalization rate was observed at the end of the first-line strategy. 3 On the contrary, other studies showed better technical results of CoT in ICA terminus occlusions compared with standalone SR 5,6 or CA. 4 We infer that the authors shared a common opinion about the synergistic effect of stent-like retrievers and the aspiration catheter that could increase the rate of better early reperfusion and FPE.…”

Section: Cot Versus Ca and Srmentioning

confidence: 91%

“…No significant differences were reported about intraprocedural complications when the 3 techniques were compared. 4,5,11,12 ICA Terminus: A Location for New Devices and Techniques?…”

Section: Cot Versus Ca and Srmentioning

confidence: 99%

Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial

Sgreccia,

Desilles,

Costalat

et al. 2024

Stroke

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BACKGROUND: The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions. METHODS: Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III (European Cooperative Acute Stroke Study) grades, and 3-month modified Rankin Scale). RESULTS: Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32–60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39–11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA. CONCLUSIONS: First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03290885.

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A Meta-analysis of Combined Aspiration Catheter and Stent Retriever versus Stent Retriever Alone for Large-Vessel Occlusion Ischemic Stroke

Cited by 18 publications

References 26 publications

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial

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