Rescue therapy is a predictor of poor outcomes, the Korean study also confirms.
Compared with contact aspiration, using stent retriever thrombectomy as a first-line approach for the treatment of large vessel occlusion (LVO) stroke is associated with more rapid recanalization, reduced need for rescue therapy, and ultimately better outcomes, according to a multicenter registry analysis published online recently in the Journal of NeuroInterventional Surgery.
The study authors, led by Dong-Hun Kang, MD (Kyungpook National University, Daegu, South Korea), note that stent retriever thrombectomy and contact aspiration are the mainstays of endovascular thrombectomy for LVO stroke. “Although a recent randomized clinical trial showed no difference in the final recanalization rate and clinical outcome,” they write, “differences that exist in procedural details and outcomes between the two modalities have not been clarified.”
The investigators identified 955 consecutive Korean patients from prospectively maintained registries of 17 comprehensive stroke centers who underwent endovascular thrombectomy for anterior circulation LVO stroke from 2011 through 2015. Among these patients, 526 received stent retriever thrombectomy as first-line therapy and 429 received contact aspiration.
There were no differences between the two groups with respect to final recanalization rate. Patients treated with a stent retriever as first-line modality, however, had higher rates of recanalization and higher rates of first-pass recanalization compared with contact aspiration as first-line modality. In addition, contact aspiration required a larger mean number of passes, and those patients were more likely to require rescue therapy.
Outcomes by First-line Technique
|
|
Stent Retriever (n = 526) |
Contact Aspiration (n = 429) |
P Value |
|
Successful Recanalization |
82.1% |
80.2% |
0.454 |
|
Switch to/Simultaneous Use of Another Modality |
6.1% |
20% |
< 0.001 |
|
First-Pass Recanalization |
35.6% |
15.4% |
< 0.001 |
|
Mean Number of Passes |
2.2 |
3.0 |
< 0.001 |
|
Rescue Treatment |
25.5% |
33.8% |
0.005 |
Mean puncture-to-recanalization time was significantly longer for patients who required rescue therapy than for those who did not (93 vs 53 min; P < 0.001).
After adjustment, the use of contact aspiration as the first-line technique remained an independent predictor of the need for rescue therapy (OR 1.37; 95% CI 1.02-1.83). In addition, the need for rescue therapy was negatively associated with good outcome (OR 0.60; 95% CI 0.41-0.87).
Kang et al note that the ASTER trial previously showed that the need for rescue therapy was associated with poorer outcomes. The results of the new study, they add, suggest that the same is true in real-world practice in South Korea.
“The study population represented at least 15% of all real-world patients who received [endovascular therapy] in our country during the study period, which were inferred from nationwide data of the Health Insurance Review and Assessment Service,” they write. “Therefore, it is worthy of note that the results of this study would reflect the endovascular therapy situation in real-world practice.”
Source:
Kang DH, Kim JW, Kim BM, et al. Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy. J NeuroIntervent Surg. 2019;Epub ahead of print.
Disclosures:
Kang reports no relevant conflicts of interest.
