As seen in the overall ASTER trial, a subanalysis shows the two techniques yield similar efficacy and safety outcomes.
Middle cerebral artery M2 segment occlusions can be just as safely and effectively treated with contact aspiration thrombectomy as with stent-retriever thrombectomy, according to a post-hoc analysis of the ASTER trial published online ahead of the February 2018 issue of Stroke.
“Middle cerebral artery M2-segment occlusions represent an important subgroup of patients with acute stroke with large-vessel occlusion,” lead author Benjamin Gory, MD, PhD (University Hospital of Nancy, France), told Neurovascular Exchange. Mechanical thrombectomy is usually used to treat these blockages, but less is known about how contact aspiration and stent-retriever use stack up against each other in this setting, he said.
For the original ASTER trial, 381 patients with large-vessel occlusions of the anterior circulation were randomized to a first-line contact aspiration (n = 192) or first-line stent-retriever (n = 189) approach immediately prior to mechanical thrombectomy. No differences between the two groups were seen with respect to rates of complete revascularization or clinical outcomes.
For the post-hoc analysis, Gory and colleagues examined outcomes among the 79 patients who had M2 segment occlusions. Of these patients, 48 were allocated to the contact aspiration and 31 to stent-retriever thrombectomy.
As with the main analysis, no differences were seen between the two groups of patients with respect to reperfusion rates or clinical outcome, based on 90-day mRS.
Outcomes by Treatment Type
|
|
Contact Aspiration (n = 48) |
Stent-Retriever Thrombectomy (n = 31) |
P Value |
|
mTICI 2b/3 |
89.6% |
83.9% |
0.36 |
|
mTICI 2c/3 |
54.2% |
54.8% |
0.90 |
|
mTICI 3 |
35.4% |
41.9% |
0.36 |
|
90-Day mRS ≤2 |
54.4% |
50.0% |
0.84 |
In addition, there were no differences between the two groups with respect to mean change in 24-hour NIHSS score (mean difference of -3.9; 95% CI -7.9-0.01) or in ASPECTS (mean difference of 0.9; 95% CI, -0.1-2.0).
The only difference in safety outcomes between the two groups was a trend toward a greater 90-day mortality among those treated with contact aspiration (19.6% vs 3.3%; P = 0.078).
“Our study suggests that effectiveness and safety should not be an argument in the choice of the first-line strategy for MT of isolated M2 occlusions,” said Gory, since the two strategies yield similar results.
What remains to be determined, he said, is how mechanical thrombectomy compares with intravenous thrombolysis for the treatment of M2 occlusions.
Source:
Gory B, Lapergue B, Blanc R, et al. Contact aspiration versus stent retriever in patients with acute ischemic stroke with M2 occlusion in the ASTER randomized trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Stroke. 2017;Epub ahead of print.
Disclosure:
Gory reports no relevant conflicts of interest.
