Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion. The ASTER Randomized Clinical Trial

Introduction: Mechanical thrombectomy has become the cornerstone and standard of care for acute stroke patients. Early reperfusion in patients experiencing acute ischemic stroke is the most important factor. The motivation behind this investigation is to display the aftereffects of mechanical thrombectomy in patients with large vessel occlusion in anterior and posterior circulation and to demonstrate that it lessens the level of handicap 3 months post stroke. Methods: A retrospective analysis was conducted of patients who presented with acute ischemic stroke at our center from 2015 to 2018 and received mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters without the bridging technique. Result factors including recanalization rate and modified Rankin Scale at 90 days post procedure were assessed. An aggregate of 30 patients were included. Results: About 30 patients presented at the institute and met the inclusion criteria for the study. Successful recanalization (the Thrombolysis in Cerebral Infarction Score [TICI 2B]) was accomplished in 90% of patients, TICI 3 score was accomplished in 56% of the patients. 67% of the patients had good modified Rankin Scale score 0-2 result at 90 days. There were 3 symptomatic hemorrhages and 3 procedure and comorbidity-related deaths (10%). Conclusion: Mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters alone without the bridging technique is an effective and safe procedure for endovascular revascularization of large vessel occlusion presenting with acute ischemic stroke.

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‘Real-world’ comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014624 ◽

2019 ◽

Vol 11 (10) ◽

pp. 957-963 ◽

Cited By ~ 7

Author(s):

Michael Martini ◽

J Mocco ◽

Aquilla Turk ◽

Adnan H Siddiqui ◽

David Fiorella ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Real World ◽

Mechanical Thrombectomy ◽

Stent Retriever ◽

Large Vessel ◽

Treatment Technique ◽

Large Vessel Occlusion ◽

First Line ◽

Vessel Occlusion

BackgroundThrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to ’real-world' practice.ObjectiveTo compare revascularization rates and outcomes for direct aspiration (ADAPT) and stent retriever thrombectomy following anterior acute ischemic stroke (AIS) in a real-life setting.MethodsData from the most recent 20 consecutive patients with AIS treated with mechanical thrombectomy between 2015 and 2016 were collected from 15 high-volume stroke centers across North America for a total of 300 cases. Patients with proximal anterior large vessel occlusions were dichotomized by primary treatment technique. Ordinal logistic regression assessed the effects of clinical variables on patient disability using 90-day modified Rankin Scale (mRS) scores.ResultsAdequate revascularization (Thrombolysis in Cerebral Infarction ≥2b) was ultimately achieved in 91.2% of first-line direct aspiration (ADAPT) cases with an average of 1.9±1.9 passes and in 87.5% of stent retriever cases with an average of 1.7±1.0 passes. Time from groin puncture to revascularization was shorter for ADAPT cases. The mean 90-day mRS score for both groups was 3.0±2.4. Number of passes using primary technique, and postintervention intracranial hemorrhage, were significant predictors of 90-day mRS scores after ADAPT, while age and preprocedure mRS score were predictive of outcomes following first-line stent retriever.ConclusionsOur data show similar adequate revascularization rates and 90-day functional outcomes for first-line direct aspiration and stent retrievers for anterior large vessel occlusion in a real-world setting. These results support the findings of other prospective trials evaluating the two techniques.

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Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion

JAMA ◽

10.1001/jama.2017.9644 ◽

2017 ◽

Vol 318 (5) ◽

pp. 443 ◽

Cited By ~ 269

Author(s):

Bertrand Lapergue ◽

Raphael Blanc ◽

Benjamin Gory ◽

Julien Labreuche ◽

Alain Duhamel ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stent Retriever ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion

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Neurointerventional therapy for large vessel occlusion stroke: the new standard of care

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v4i16.316 ◽

2016 ◽

Vol 4 (16) ◽

pp. 26

Author(s):

Pavis Laengvejkal ◽

Doungporn Ruthirago ◽

Parunyou Julayanont ◽

Yazan Alderazi

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Standard Of Care ◽

Stent Retriever ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

The Past ◽

Iv Tpa

For the past two decades, intravenous tissue plasminogenactivator (IV tPA) has been the gold standardtreatment of acute ischemic stroke (AIS) for patientspresenting to the hospital in the first 4.5 hours aftersymptom onset. However, in patients with AIS due tointracranial large vessel occlusion (LVO), IV tPA hasvery poor recanalization rates. This group of patientshas significantly worse outcomes than those withoutLVO. Endovascular therapy has evolved significantlysince the first trial in 1998. With the publication of recenttrials using modern stent-retriever devices andselection of patients with LVO, endovascular therapyhas become the standard of care for patients with themost severe ischemic strokes. In this article we outlinethe two decade evolution of this therapy.

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Abstract 1122‐000185: Rescue Intracranial Stenting in Acute Ischemic Stroke

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000185 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Mais N Al‐Kawaz ◽

Satvros Matsoukas ◽

Christopher P Kellner ◽

J Mocco ◽

Johanna T Fifi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Median Number ◽

Stent Retriever ◽

Large Vessel ◽

Neurologic Outcome ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Intracranial Stenting ◽

Symptomatic Intracerebral Hemorrhage

Introduction : Rescue treatment for failed thrombectomy in patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) remains controversial. We report our institutional experience with using intracranial stenting of occlusion refractory to aspiration and stent retriever thrombectomy. Methods : We performed a retrospective review of our prospectively maintained thrombectomy database to identify the LVO AIS patients who underwent intracranial stenting during endovascular thrombectomy at our comprehensive stroke center between January 2015 and July 2021. Modified Rankin scale (mRS) at 90 days was used as primary outcome. A good neurologic outcome was defined as mRS 0–3, and a poor neurologic outcome is defined as mRS score between 4–6. Secondary outcomes included symptomatic intracerebral hemorrhage (sICH) based on ECASS criteria, and in‐hospital mortality. Results : We identified 52 acute ischemic stroke patients who underwent intracranial stenting acutely. Thirty‐three patient (63.4%) are males. Median age was 64 years (Interquartile range (IQR 57–74), median baseline mRS was 0 (IQR 0–1), median NIHSS score was 13 (IQR 7–18), and median ASPECTS was 9 (IQR 8–10). Thirty six percent of the patients had a vertebrobasilar occlusion, 34% had a middle cerebral occlusion (M1 segment), and 14% had an M2 segment occlusion. The median number of thrombectomy passes prior to stenting was 3 (IQR 2–4). In 48% of patients, a combination of aspiration and stent retriever techniques were used prior to intracranial stenting. The Enterprise stent was the most commonly used stent (51.9%), followed by Wingspan stent (25%), and Neuroform Atlas stent (21.5%). Majority of the patients (93%) were loaded with anti‐thrombotics intraoperatively, with rectal Aspirin and intravenous Integrilin being the most commonly used agents. Successful recanalization (TICI 2 B or better) was achieved in 96% of the patients, while the remaining 2 patients were graded as TICI 2A recanalization. Fifty percent of the patients had good outcome at 90 days. A total of 4 patients (8%) developed a sICH, with a 90 day mortality of rate of 15.4% (8/52). Conclusions : Rescue intracranial stenting appears to be a safe and effective approach in patients with emergent large vessel occlusion refractory to thrombectomy. Larger studies are warranted to further establish the safety and efficacy of this approach.

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