Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters

Jindal, Gaurav; Serulle, Yafell; Miller, Timothy R; Le, Elizabeth; Wozniak, Marcella A.; Phipps, Michael; Iyoha, Moronke; Gupta, Vikash; Shivashankar, Ravi; Gandhi, Dheeraj

doi:10.1136/neurintsurg-2016-012581

Cited by 28 publications

(23 citation statements)

References 20 publications

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“…The first line use of contact aspiration versus stent retriever thrombectomy in LVO is evolving as a more common technique, but evidence to support its use is mixed. This technique, specifically one called “a direct aspiration as first pass technique” (ADAPT), has been studied because observational studies suggested that it might lead to earlier reperfusion and lower cost of thrombectomy 7374. This led to two randomized clinical trials, ASTER (Contact Aspiration versus Stent Retriever for Successful Revascularization) in 2017 and COMPASS (Aspiration Thrombectomy Versus Stent Retriever Thrombectomy as First-Line Approach for Large Vessel Occlusion) in 2019,757677 which both examined the ADAPT technique versus stent retriever within six hours of onset.…”

Section: Mechanical Thrombectomy For Acute Ischemic Strokementioning

confidence: 99%

Management of acute ischemic stroke

Phipps

Cronin

2020

BMJ

439

315

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Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.

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Section: Mechanical Thrombectomy For Acute Ischemic Strokementioning

confidence: 99%

Management of acute ischemic stroke

Phipps

Cronin

2020

BMJ

439

315

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“…Both European and American recommendations propose that clinical trials be conducted to determine the thrombectomy device that achieves the highest rate of successful recanalization 1–4. Contact aspiration (CA) is a novel thrombectomy technique involving aspiration of the thrombus through a large-bore catheter 5–18. The CA technique employs large-bore aspiration catheters that have the advantage of being easily tracked for introduction into the cerebral circulation and removal of the thrombus via negative pressure aspiration.…”

Section: Introductionmentioning

confidence: 99%

Combined use of contact aspiration and the stent retriever technique versus stent retriever alone for recanalization in acute cerebral infarction: the randomized ASTER 2 study protocol

Lapergue¹,

Labreuche

Blanc

et al. 2020

J NeuroIntervent Surg

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RationaleMechanical thrombectomy (MT) using a stent retriever (SR) device is currently the recommended treatment in ischemic stroke due to anterior circulation large vessel occlusion. Combining contact aspiration (CA) with SR is a promising new treatment, although it was not found to be superior to SR alone as first-line treatment for achieving successful reperfusion.AimTo determine whether endovascular treatment combining first-line use of CA and SR is more efficient than SR alone.MethodsThe ASTER 2 clinical trial is a prospective, randomized, multicenter, open-label trial with a blinded endpoint. We included patients admitted with suspected anterior circulation ischemic stroke secondary to large vessel occlusion <8 hours from symptom onset. They were randomly allocated in a 1:1 ratio to one of two treatment groups (combined CA and SR or SR alone). In the case of failure of the assigned technique after three attempts, other adjunctive techniques were applied.Study outcomeThe primary outcome is the rate of successful/complete reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score 2c/3) after the entire endovascular procedure. Secondary outcomes include reperfusion rates after the assigned first-line intervention alone and at the end of the procedure, procedural times, change in NIH Stroke Scale score at 24 hours, intracerebral hemorrhage at 24 hours, procedure-related serious adverse events, the modified Rankin Scale score, and all-cause mortality at 90 days and 1 year. The cost effectiveness of the two procedures will also be analyzed.DiscussionThis is the first head-to-head randomized trial to directly compare the efficacy of the combined use of CA and SR versus SR alone. This prospective trial aims to demonstrate the synergistic effects of CA and SR devices in first-line endovascular treatment.

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“…Regarding procedures, the rate of combined procedure using a stent retriever with aspiration catheter was approximately 70% in the favorable and unfavorable outcome groups. Several studies have reported the advantages of combined procedures, [14][15][16] but we have performed the procedure, emphasizing that a higher recanalization rate was achieved on the first pass than the procedures with a stent retriever or aspiration catheter alone. 17) In this study, combined procedures comprised the greater portion.…”

Section: The Evt Groupmentioning

confidence: 99%

Current Status of Treatment for Acute Large Vessel Occlusion Stroke in Awaji Island Area after the Introduction of Endovascular Treatment

Mizowaki

Nakahara

Fujita

et al. 2020

JNET

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Objective:We retrospectively analyzed the current status of treatment for anterior circulation large vessel occlusion (LVO) in island areas with a high population aging rate. Methods:We investigated 62 consecutive patients with ischemic stroke due to acute anterior circulation LVO between Results: In all, 26 (41.1%) patients underwent endovascular treatment (EVT). The successful recanalization rate of EVT was 88.5% (23/26). There was a significant difference in the age (median, 75.5 years vs. 81 years, respectively, P = 0.0411) and the rate of intravenous tissue plasminogen activator (tPA) therapy (53.5% vs. 11.1%, respectively, P <0.001) between the EVT group and the non-EVT group. Patients in the EVT group achieved a favorable outcome more frequently than those in the non-EVT group (50% vs. 11.1%, respectively, P = 0.0012). In the analysis based on the place of onset among the three cities comprising Awaji Island and the four groups with in-hospital onset, there was no significant difference in the rate of EVT, and the outcome of the in-hospital onset group was poor. Among the EVT group, there was a significant difference in the pre-treatment National Institutes of Health Stroke Scale score (median, 15 vs. 19, respectively, P = 0.0237) and time from onset to recanalization (O2R; median, 240 min vs. 323 min, respectively, P = 0.0128) between the favorable outcome group and the unfavorable outcome group. Conclusion:Even in an island area, it is possible to complete the treatment of ischemic stroke due to LVO within the regional medical area.Keywords▶ acute ischemic stroke, large vessel occlusion, endovascular treatment

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Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters

Abstract: When using SRs for intracranial stroke thrombectomy, the concurrent use of IACs is associated with a decrease in procedural time and thrombectomy attempts compared with use of SRs alone.

Cited by 28 publications

References 20 publications

Management of acute ischemic stroke

Management of acute ischemic stroke

Combined use of contact aspiration and the stent retriever technique versus stent retriever alone for recanalization in acute cerebral infarction: the randomized ASTER 2 study protocol

Current Status of Treatment for Acute Large Vessel Occlusion Stroke in Awaji Island Area after the Introduction of Endovascular Treatment

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