There were no differences in reperfusion or complication rates, but direct aspiration procedures were significantly shorter.
Mechanical thrombectomy for the treatment of acute ischemic stroke offers similar outcomes and complication rates irrespective of whether patients are treated using a stent retriever or direct aspiration approach, according to a real-world analysis of the Dutch MR CLEAN Registry.
While stent retriever thrombectomy has become a gold standard for the endovascular treatment of acute ischemic stroke, “the efficacy of contact aspiration on functional outcome has not been shown so far,” lead author Marie Louise Elisabeth Bernsen, MD (Rijnstate Hospital Arnhem, the Netherlands), explained to Neurovascular Exchange in an email.
For their paper published online recently ahead of print, in the Journal of NeuroInterventional Surgery, Bernsen and colleagues analyzed data on 1,175 patients with a large vessel occlusion of the anterior circulation who underwent endovascular therapy and were registered in the Dutch MR CLEAN Registry between March 2014 and June 2016. Of these patients, 17.6% were treated using direct aspiration and 82.4% using a stent retriever.
There were no differences in functional outcome (adjusted cOR 1.02; 95% CI 0.68-1.52) or in rates of periprocedural complications between the two groups of patients. Rates of successful reperfusion were also similar, but the duration of the procedure was shorter with direct aspiration.
“Consequently, the time from onset of symptoms to reperfusion was shorter in patients treated with aspiration,” the study authors write. “This finding is in line with the ASTER trial and reported but as of yet unpublished results of the COMPASS trial.”
Outcomes of Direct Aspiration vs Stent Retriever Thrombectomy
|
|
Aspiration (n = 207) |
Stent Retriever (n = 968) |
P Value |
|
90-Day mRS 0-2 |
38% |
37% |
0.72 |
|
Serious Adverse Events |
41% |
43% |
0.71 |
|
eTICI 2b/3 |
63% |
56% |
0.06 |
|
Mortality |
27% |
26% |
0.93 |
|
Median Duration of Procedure, min |
56.5 |
70 |
0.0001 |
“Our study shows that direct aspiration is safe and effective in the treatment of acute ischemic stroke,” Bernsen told NVX, adding, that the registry data confirm what has been reported in randomized trials. “This finding forms a platform for further research and thus optimization of endovascular therapy. This will eventually benefit clinical outcomes,” she predicted.
Bernsen highlighted the importance of the fact that the study represents real-world outcomes. “The results are representative for daily clinical practice,” she noted. “Our data reflects performance of either approach by someone who is experienced with the technique. Randomized studies may ‘force’ proceduralists not familiar with a technique to use it if the subject is randomized to a particular arm.”
Source:
Bernsen MLE, Goldhoorn R-JB, van Oostenbrugge RJ, et al. Equal performance of aspiration and stent retriever thrombectomy in daily stroke treatment. J NeuroIntervent Surg. 2018;Epub ahead of print.
Disclosures:
Bernsen reports no relevant conflicts of interest.
