Abstract P365: Effect of Radiological Thrombus Characteristics on Results of First-Line Endovascular Treatment Approach for Acute Ischemic Stroke

Introduction: Pervious thrombi benefit more from intravenous thrombolysis, but the role of perviousness in endovascular treatment (EVT) is not completely clear. Thrombus length is negatively associated with outcome after EVT. Pervious, long thrombi may be more difficult to aspirate, or fragment more easily than non-pervious, short thrombi. We assessed the effect of perviousness and thrombus length on results of first-line aspiration thrombectomy in EVT, in comparison to stent-retrievers. Methods: We included MR CLEAN Registry patients (N=1526) with thin-slice imaging available, and aspiration or stent-retriever as first EVT attempt (N=391). Thrombus perviousness was measured by thrombus attenuation increase (Houndsfield Units; HU). Associations with 90-day modified Rankin Scale score (mRS), and final and first-pass reperfusion (eTICI 2B-3) were tested with adjusted logistic regression analyses. Results: Sixty-five (21%) patients were treated with first-line aspiration, 252 (79%) with stent-retrievers. Perviousness was not significantly associated with mRS after either first-line approach (Figure 1). Analysis per perviousness quartile did show improved mRS for stent-retrievers in the highest quartile only (>12.3 HU; acOR for mRS shift with stent-retriever treatment 3.08, 95%CI 1.06-8.96). Thrombus length was negatively associated with mRS after first-line stent-retriever thrombectomy (acOR 0.96, 95%CI 0.93-0.99). First-pass reperfusion and thrombus length were significantly, negatively associated in the first-line aspiration group (acOR 0.88, 95%CI 0.80-0.96). Conclusions: Patients with longer thrombi may show worse outcomes after both aspiration and stent-retriever thrombectomy. In patients with high perviousness values, stent-retriever thrombectomy may be related to improved outcomes as compared to first-line aspiration.

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Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014696 ◽

2019 ◽

Vol 11 (10) ◽

pp. 979-983 ◽

Cited By ~ 9

Author(s):

Dong-Hun Kang ◽

Jin Woo Kim ◽

Byung Moon Kim ◽

Ji Hoe Heo ◽

Hyo Suk Nam ◽

...

Keyword(s):

Stent Retriever ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Endovascular Thrombectomy ◽

Negatively Associated ◽

Good Outcome ◽

Rescue Treatment ◽

First Pass

BackgroudThe need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT.MethodsWe identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome.ResultsA total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870).ConclusionCA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.

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Clot perviousness is associated with first pass success of aspiration thrombectomy in the COMPASS trial

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016434 ◽

2020 ◽

pp. neurintsurg-2020-016434

Author(s):

Maxim Mokin ◽

Muhammad Waqas ◽

Johanna Fifi ◽

Reade De Leacy ◽

David Fiorella ◽

...

Keyword(s):

Multivariate Analysis ◽

Stent Retriever ◽

Hounsfield Units ◽

First Line ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Post Contrast ◽

Imaging Characteristics ◽

First Pass ◽

Post Hoc

BackgroundClot density (Hounsfield units, HU) and perviousness (post-contrast increase in the HU of clot) are thought to be associated with clot composition. We evaluate whether these imaging characteristics were associated with angiographic outcomes of aspiration and stent retriever thrombectomy in COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion.MethodsClot density and perviousness were measured by two independent operators who were blind to all the final angiographic and clinical outcomes. The association of clot density and perviousness with the Thrombolysis In Cerebral Infarction (TICI) scale after first pass was assessed using univariate and multivariate analysis.ResultsAmong all patients enrolled in COMPASS, 165 were eligible for the post-hoc analysis (81 patients in the aspiration first and 84 in the stent retriever first groups). Overall mean perviousness of clot was significantly higher in patient with mTICI 2b-3 after first pass (28.6±22.9 vs 20.3±19.2, p=0.017). Mean perviousness among patients who achieved TICI 2c/3 versus TICI 2b versus TICI 0-2a in the aspiration first group varied significantly (32.6±26.1, 35.3±24.4, and 17.7±13.1, p=0.013). The association of perviousness with first pass success was not significant in the stent retriever group. Using multivariate analysis, high perviousness (defined as cut-off >27.6) was an independent predictor of TICI 2b-3 (OR 3.82, 95% CI 1.10 to 13.19; p=0.034).ConclusionsClot perviousness is associated with first pass angiographic success in patients treated with the aspiration first approach for thrombectomy.

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Abstract TP34: Endovascular Thrombectomy for M1 Vessel Occlusion: Comparison Between Stent Retriever Mediated Thrombectomy and Forced Aspiration Thrombectomy

Stroke ◽

10.1161/str.48.suppl_1.tp34 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Michelle Nunes ◽

Pedro Aguilar-Salinas ◽

Thais Varzoni ◽

John Entwistle ◽

Eric Sauvageau ◽

...

Keyword(s):

Statistical Significance ◽

High Volume ◽

Stent Retriever ◽

Stroke Therapy ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Endovascular Thrombectomy ◽

Improved Outcomes ◽

Stent Retrievers ◽

Single Modality

Introduction: An evolution in endovascular approaches has been observed in the last decade with stent retrievers (ST) being the latest generation of devices. Stent retriever thrombectomy and manual aspiration (MAT) have each shown to lead to high rates of recanalization as single modality endovascular stroke therapy. We aimed to compare clinical outcomes, efficacy and safety of ‘stent retriever mediated manual aspiration thrombectomy’ and manual aspiration thrombectomy (MAT) alone. Methods: 145 patients with M1 vessel circulation stroke and had undergone thrombectomy treatment were identified between March 2014 and June 2016 in two high volume centers. The patient’s data were retrospectively analyzed to evaluate the technical characteristics, angiographic outcome (Thrombolysis In Cerebral Infarct - TICI score) and clinical outcome at discharge (NIHSS and mRS) Results: 69 patients were treated with ST (Solitaire and Trevo) and 76 with MAT. IV-TPA was administered in 37.4% of cases. Effective recanalization, TICI grades 2b/3, was achieved in 84.1% of cases treated with ST and in 89.5% treated with aspiration with no statistical significance between the two techniques. Symptomatic cerebral hemorrhage was found in 4.3% of the cases. Favorable outcome defined as a mRS of 0-2 at discharge was found in 38% of cases with higher rates in the group treated with ST (56.1% vs 33.3%; p 0.01). Conclusion: Stent retriever mediated manual aspiration thrombectomy is a safe and efficacious method of achieving high revascularization rates for M1 vessel occlusion with improved outcomes at discharge.

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EXPRESS: Stent Retriever Alone vs. Aspiration and Stent-Retriever Combination in Large Vessel Occlusion Stroke: A Matched Analysis

International Journal of Stroke ◽

10.1177/17474930211019204 ◽

2021 ◽

pp. 174749302110192

Author(s):

Mahmoud H Mohammaden ◽

Diogo C. Haussen ◽

Leonardo Pisani ◽

Alhamza Al-Bayati ◽

Aaron Anderson ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Functional Independence ◽

Stent Retriever ◽

Sensitivity Analyses ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Guide Catheter ◽

First Pass ◽

Combined Technique

Background Three randomized clinical trials have reported similar safety and efficacy for contact aspiration (CA) and Stent-retriever (SR) thrombectomy. Aim We aimed to determine whether the Combined Technique (SR+CA) was superior to SR alone as first-line thrombectomy strategy in a patient cohort where balloon-guide catheter was universally used. Methods A prospectively maintained mechanical thrombectomy database from January 2018-December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent SR alone thrombectomy or SR+CA as first-line therapy. The primary outcome was the first-pass effect (FPE) (mTICI2c-3). Secondary outcomes included modified FPE (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS â¤2). Safety outcomes included rate of parenchymal hematoma (PH) type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. Results A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16[11-21]). As compared to first-line SR alone, first-line SR+CA resulted in similar rates of FPE (53% vs. 51%,aOR 1.122, 95%CI[0.745-1.691],p=0.58), mFPE (63% vs. 60.4%,aOR1.250, 95%CI[0.782-2.00],p=0.35), final successful reperfusion (97.6% vs. 98%,p=0.75) and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%,aOR 2.033, 95%CI[1.209-3.419],p=0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line SR+CA treatment (81.8% vs. 73.6%,aOR 1.881, 95%CI[1.039-3.405],p=0.037). Conclusions Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a Combined Technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, addition of contact aspiration after initial SR failure might be beneficial in achieving earlier reperfusion.

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Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

Journal of Clinical Medicine ◽

10.3390/jcm10091802 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1802

Author(s):

Grzegorz Meder ◽

Paweł Żuchowski ◽

Wojciech Skura ◽

Violetta Palacz-Duda ◽

Milena Świtońska ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Statistical Significance ◽

Stent Retriever ◽

Single Center Experience ◽

Significant Difference ◽

First Pass ◽

Need To Evaluate ◽

The Difference

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.

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First-line contact aspiration versus first-line stent retriever for acute posterior circulation strokes: an updated meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017497 ◽

2021 ◽

pp. neurintsurg-2021-017497

Author(s):

Gengfan Ye ◽

Xuebin Wen ◽

Hongcai Wang ◽

Chengfeng Sun ◽

Zhihao Pan ◽

...

Keyword(s):

Observational Studies ◽

Meta Analysis ◽

Functional Independence ◽

Posterior Circulation ◽

Stent Retriever ◽

First Line ◽

Random Effects Models ◽

First Pass

BackgroundBoth stent retriever (SR) and contact aspiration (CA) are widely used as first-line strategies for acute posterior circulation strokes (PCS). However, it is still unclear how CA and SR compare as the first-line treatment of acute PCS. Several new studies have been published recently, so we aimed to perform an updated meta-analysis.MethodsThe meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Random-effects models were performed to pool the outcomes and the value of I2 was calculated to assess the heterogeneity.ResultsTen observational studies with 1189 patients were included, among whom 492 received first-line CA and 697 received first-line SR. The pooled results revealed that first-line CA could achieve a significantly higher proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3 (OR 1.90, 95% CI 1.33 to 2.71, I2=0%), mTICI 3 (OR 1.95, 95% CI 1.15 to 3.31, I2=59.6%), first-pass effect (OR 2.91, 95% CI 1.51 to 5.58, I2=0%), lower incidence of new-territory embolic events (OR 0.20, 95% CI 0.05 to 0.83, I2=0%), and shorter procedure time (mean difference −29.4 min, 95% CI −46.8 to −12.0 min, I2=62.8%) compared with first-line SR. At 90-day follow-up, patients subjected to first-line CA showed a higher functional independence (modified Rankin Scale score 0–2; OR 1.38, 95% CI 1.01 to 1.87, I2=23.5%) and a lower mortality (OR 0.71, 95% CI 0.50 to 1.00, p=0.050, I2=0%) than those subjected to first-line SR.ConclusionsThis meta-analysis suggests that the first-line CA strategy could achieve better recanalization and clinical outcomes for acute PCS than first-line SR. Limited by the quality of included studies, this conclusion should be drawn with caution.

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Abstract P33: Blind Exchange With the Mini-Pinning Technique Using Tron Fx Retriever for M2 Occlusion Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p33 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Takeshi Yoshimoto

Keyword(s):

Stent Retriever ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Target Vessel ◽

Stroke Patients ◽

Technical Improvement ◽

Vessel Size ◽

Blind Navigation ◽

First Pass ◽

Stent Retrievers

Introduction: Technical improvement to enhance M2 occlusion thrombectomy is desirable. Tron FX® is the only stent-retriever that can be deployed through 0.0165-inch microcatheters. Here we report outcomes of blind exchange with mini-pinning (BEMP) technique using Tron stent-retrievers. Methods: Consecutive stroke patients with M2 occlusion treated with 2 x15 mm or 4 x 20 mm Tron stent-retrievers using the BEMP technique were included. The technique involves the deployment of a Tron stent-retriever through a 0.0165-inch microcatheter followed by microcatheter removal and blind navigation of a 3/4MAX aspiration catheter over the bare Tron delivery wire until the aspiration catheter reaches the clot,. Tron stent-retriever was inserted into aspiration catheter like corkscrew, and subsequently pulled as a unit. A first pass effect (FPE), modified FPE (mFPE) and modified Rankin Scale (mRS) score at 90 days were assessed as outcomes. Results: Fifteen M2 vessels were treated in 13 patients (5 women, median 81 years of age, and median National Institutes of Health Stroke Scale score 18 [11–25]). BEMP technique was successful in all cases. Whether to use 3MAX or 4MAX was determined according to the target vessel size while proceeding with the procedure (3MAX, n=8; 4MAX, n=5). Final mTICI 2b–3 was achieved in 92% (12/13). FPE and mFPE rates were 50% and 64%, respectively. Six patients (46%) were achieved in mRS score 0–2 at 3 months. Conclusions: Tron stent-retriever was successfully and safely used in the BEMP technique for M2 occlusion

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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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014735 ◽

2020 ◽

Vol 12 (5) ◽

pp. 471-476 ◽

Cited By ~ 4

Author(s):

Bertrand Lapergue ◽

Julien Labreuche ◽

Raphaël Blanc ◽

Gaultier Marnat ◽

Arturo Consoli ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Infarction ◽

Endovascular Treatment ◽

Scale Score ◽

Stent Retriever ◽

Large Vessel Occlusion ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Combined Use

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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Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

BMC Neurology ◽

10.1186/s12883-020-02013-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jin Wook Choi ◽

Miran Han ◽

Jung Hyun Park ◽

Woo Sang Jung

Keyword(s):

Basilar Artery ◽

Mechanical Thrombectomy ◽

Treatment Method ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Procedure Time ◽

First Line ◽

Aspiration Thrombectomy ◽

First Pass ◽

First Line Treatment

Abstract Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.

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Balloon Guide Catheter is Not Superior to Conventional Guide Catheter when Stent Retriever and Contact Aspiration are Combined for Stroke Treatment

Neurosurgery ◽

10.1093/neuros/nyaa315 ◽

2020 ◽

Vol 88 (1) ◽

pp. E83-E90

Author(s):

Romain Bourcier ◽

Gaultier Marnat ◽

Julien Labreuche ◽

Hubert Desal ◽

Federico Di Maria ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Clinical Outcomes ◽

Stent Retriever ◽

Added Value ◽

Complete Revascularization ◽

First Line ◽

Stroke Treatment ◽

Guide Catheter ◽

Significant Difference

Abstract BACKGROUND The effectiveness of balloon guide catheter (BGC) use has not been prospectively studied and its added value for improving reperfusion in acute ischemic stroke (AIS) treatment has only been reported in studies in which no contact aspiration was combined with the stent retriever (CA + SR). OBJECTIVE To compare the reperfusion results and clinical outcomes with and without BGC use when a combined CA + SR strategy is employed in first line to treat AIS. METHODS From January 2016 to April 2019, data from the ETIS registry (Endovascular Treatment in Ischemic Stroke) were reviewed. We included patients having undergone endovascular treatment with a combined CA + SR strategy and use or not of a BGC according to the operator's discretion. We compared BGC and nonBGC populations with matching and inverse probability of treatment weighting propensity scores. Primary outcome was the final near-complete/complete revascularization (mTICI2c/3) rate. Secondary outcomes included clinical outcomes and safety considerations. RESULTS Among 607 included patients, BGC was used in 32.9% (n = 200), and 190 matched pairs could be found. We found no significant difference in final mTICI2c/3 between patients with and without BGC (60.1% in BGC group compared to 62.7% in nonBGC group (matched RR, 0.92; 95%CI, 0.80 to 1.14)), first-pass mTICI2c/3 (35.1% vs 37.3%, matched RR, 0.94; 95%CI, 0.68 to 1.30), clinical outcome (matched RR of 1.12 (95%CI, 0.85 to 1.47) for favorable outcome. CONCLUSION The reperfusion and clinical results with and without BGC use are not significantly different when combined CA + SR are used as a first-line strategy for large vessel occlusion in the setting of AIS.

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