François Zhu1, Bertrand Lapergue2, Maéva Kyheng3, Raphael Blanc4, Julien Labreuche3, Malek Ben Machaa4, Alain Duhamel3, Gautier Marnat5, Suzana Saleme6, Vincent Costalat7, Serge Bracard1, Sébastien Richard8, Hubert Desal9, Mikael Mazighi4, Arturo Consoli10, Michel Piotin4, Benjamin Gory11. 1. From the Department of Diagnostic and Therapeutic Neuroradiology (F.Z., S.B., B.G.). 2. Stroke Unit, University Hospital of Nancy, University of Lorraine, INSERM U1254, IADI, Nancy, France; Department of Stroke Center (B.L.). 3. Department of Biostatistics, University Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, France (M.K., J.L., A.D.). 4. Foch Hospital, Suresnes, France; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.B.M., M.M., M.P.). 5. Department of Neuroradiology, University Hospital of Bordeaux, France (G.M.). 6. Department of Interventional Neuroradiology, University Hospital of Limoges, France (S.S.). 7. Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France (V.C.). 8. Department of Neurology (S.R.). 9. Department of Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France (H.D.). 10. Department of Neuroradiology (A.C.). 11. From the Department of Diagnostic and Therapeutic Neuroradiology (F.Z., S.B., B.G.) b.gory@chru-nancy.fr.
Abstract
BACKGROUND AND PURPOSE: The clot burden score (CBS) at admission reliably evaluates the thrombus burden in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy has been diversified, especially with contact aspiration technique, and its efficiency with respect to the thrombus burden is not known. We compared reperfusion, adverse events, neurological recovery, and 90-day functional outcome of stent retriever use versus contact aspiration according to the admission CBS. METHODS: This is a post hoc analysis of the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) randomized trial. The primary outcome was successful reperfusion after all procedures, defined as modified Thrombolysis in Cerebral Infarction scores 2b/3. Secondary outcomes were 90-day functional outcome, assessed with the modified Rankin Scale. Safety outcomes included 90-day mortality and any intracerebral hemorrhage. RESULTS:A total of 231 randomized patients were included in this study: 114 patients had a CBS of 0 to 6 and 117 a CBS ≥7 at admission. Successful reperfusion at procedure end was achieved more frequently in patients with CBS ≥7 (88.9%) than patients with a CBS 0 to 6 (81.6%; fully adjusted risk ratio, 1.09; 95% confidence interval, 1.01-1.28). Favorable outcome (modified Rankin Scale score, 0-2) at 90 days was achieved in significantly more patients with CBS ≥7 (61.9%) than in patients with CBS 0 to 6 (41.8%; fully adjusted risk ratio, 1.19; 95% confidence interval, 1.02-1.40). No outcome differences of first-line mechanical thrombectomy strategy (aspiration versus stent) on any angiographic or clinical outcomes were observed between the 2 groups. We also found no evidence of interaction between first-line mechanical thrombectomy strategy and CBS groups regarding safety. CONCLUSIONS: First-line mechanical thrombectomy with contact aspiration compared with stent retriever did not result in an increased successful reperfusion rate in acute ischemic stroke patients with large vessel occlusion of the anterior circulation according to the admission CBS. The latter, however, seems to be a reliable prognostic indicator of angiographic and clinical outcome.
RCT Entities:
BACKGROUND AND PURPOSE: The clot burden score (CBS) at admission reliably evaluates the thrombus burden in acute ischemic strokepatients with anterior circulation large vessel occlusion. Mechanical thrombectomy has been diversified, especially with contact aspiration technique, and its efficiency with respect to the thrombus burden is not known. We compared reperfusion, adverse events, neurological recovery, and 90-day functional outcome of stent retriever use versus contact aspiration according to the admission CBS. METHODS: This is a post hoc analysis of the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) randomized trial. The primary outcome was successful reperfusion after all procedures, defined as modified Thrombolysis in Cerebral Infarction scores 2b/3. Secondary outcomes were 90-day functional outcome, assessed with the modified Rankin Scale. Safety outcomes included 90-day mortality and any intracerebral hemorrhage. RESULTS: A total of 231 randomized patients were included in this study: 114 patients had a CBS of 0 to 6 and 117 a CBS ≥7 at admission. Successful reperfusion at procedure end was achieved more frequently in patients with CBS ≥7 (88.9%) than patients with a CBS 0 to 6 (81.6%; fully adjusted risk ratio, 1.09; 95% confidence interval, 1.01-1.28). Favorable outcome (modified Rankin Scale score, 0-2) at 90 days was achieved in significantly more patients with CBS ≥7 (61.9%) than in patients with CBS 0 to 6 (41.8%; fully adjusted risk ratio, 1.19; 95% confidence interval, 1.02-1.40). No outcome differences of first-line mechanical thrombectomy strategy (aspiration versus stent) on any angiographic or clinical outcomes were observed between the 2 groups. We also found no evidence of interaction between first-line mechanical thrombectomy strategy and CBS groups regarding safety. CONCLUSIONS: First-line mechanical thrombectomy with contact aspiration compared with stent retriever did not result in an increased successful reperfusion rate in acute ischemic strokepatients with large vessel occlusion of the anterior circulation according to the admission CBS. The latter, however, seems to be a reliable prognostic indicator of angiographic and clinical outcome.
Authors: Muhammad Waqas; Weizhe Li; Tatsat R Patel; Felix Chin; Vincent M Tutino; Rimal H Dossani; Zeguang Ren; Waldo R Guerrero; Cesario V Borlongan; Elliot Pressman; Kenneth Snyder; Jason M Davies; Elad I Ley; Ciprian N Ionita; Adnan H Siddiqui; Maxim Mokin Journal: Interv Neuroradiol Date: 2021-05-18 Impact factor: 1.764
Authors: Sebastian Fischer; Lukas Goertz; Charlotte S Weyland; Ali Khanafer; Christoph J Maurer; Hanna Zimmermann; Thomas David Fischer; Hanna Styczen; Benjamin Tan; Maria Alexandrou; Donald Lobsien; Elmar Lobsien; Maximilian Thormann; Lukas Meyer; Nuran Abdullayev; Jens Fiehler; Anastasios Mpotsaris; Panagiotis Papanagiotou; Leonard Yeo; Cornelius Deuschl; Thomas Liebig; Ansgar Berlis; Hans Henkes; Markus Möhlenbruch; Volker Maus Journal: J Clin Med Date: 2022-02-26 Impact factor: 4.241