Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke

Blasco, Jordi; Puig, Josep; López-Rueda, Antonio; Daunis‐i‐Estadella, Pepus; Llull, Laura; Zarco, Federico; Macías, Napoleón; Macho, Juan; González, Eva; Labayen, Ion; Vega, Pedro; Murías, Eduardo; Jimenez-Gomez, Elvira; Rey, Isabel Bravo; Moreu, Manuel; Pérez-García, Carlos; Chaparro, Oscar Chirife; Aixut, Sònia; Terceño, Mikel; Werner, Mariano; Pumar, José Manuel; Tejedor, Yeray Aguilar; Méndez, José; Moliner, Sarai; Nogueira, Raul G; Román, Luís San

doi:10.1136/neurintsurg-2021-017760

Cited by 12 publications

(21 citation statements)

References 28 publications

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“…Second, unlike previous studies, the balloon guiding catheter (BGC) was only used in 4‰ of patients from the ANGEL-ACT registry, which might also lead to different results between our and previous studies. However, Blasco et al also found that first-line SR+CA had a longer procedure duration than first-line SR alone, although all patients enrolled in their study used BGC 23. Third, the experience and preference of the neurointerventionists for the first-line thrombectomy technique might also be another possible explanation.…”

Section: Discussionmentioning

confidence: 90%

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Huo¹,

Sun²,

Hu³

et al. 2023

Stroke Vasc Neurol

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Background and purposeAn analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion (LVO) stroke between stent retrieval (SR) alone as a first-line mechanical thrombectomy (MT) technique (SR alone first-line) and concomitant use of contact aspiration (CA) plus SR as a first-line MT technique (SR+CA first-line). The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.MethodsWe conducted the present study by using the data from the ANGEL-ACT registry. We divided the selected patients into SR+CA first-line and SR alone first-line groups. We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes, including successful/complete recanalisation after the first technique alone and all procedures, first-pass successful/complete recanalisation, number of passes, 90-day modified Rankin Scale, procedure duration, rescue treatment and intracranial haemorrhage within 24 hours.ResultsOf the 1233 enrolled patients, 1069 (86.7%) received SR alone first-line, and 164 (13.3%) received SR+CA first-line. SR+CA first-line was associated with more thrombectomy passes (3 (2–4) vs 2 (1–2); β=1.77, 95% CI=1.55 to 1.99, p<0.001), and longer procedure duration (86 (60–129) min vs 80 (50–122) min; β=10.76, 95% CI=1.08 to 20.43, p=0.029) than SR alone first-line group. Other outcomes were comparable (all p>0.05) between the two groups.ConclusionsPatients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line. Additionally, we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level, first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

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Section: Discussionmentioning

confidence: 90%

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Huo¹,

Sun²,

Hu³

et al. 2023

Stroke Vasc Neurol

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“…After removing duplicates and screening for the titles and abstracts, 63 papers remained for full text review from which we excluded 58 papers (overlapping population, n=2; wrong outcome or no outcome reported, n=41; review, n=4; combined technique only used as salvage, n=2; unable to extract data, n=2; other endpoints, n=4; other, n=1). Finally, we included five studies in our meta-analysis,17 18 26–28 which included four cohort studies and one randomized trial. The quality of all of the included articles was high.…”

Section: Resultsmentioning

confidence: 99%

Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis

Teo

Sia

Tan

et al. 2022

J NeuroIntervent Surg

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BackgroundThe use of a combination of balloon guide catheter (BGC), aspiration catheter, and stent retriever in acute ischemic stroke thrombectomy has not been shown to be better than a stent retriever and BGC alone, but this may be due to a lack of power in these studies. We therefore performed a meta-analysis on this subject.MethodsA systematic literature search was performed on PubMed, Scopus, Embase/Ovid, and the Cochrane Library from inception to October 20, 2021. Our primary outcomes were the rate of successful final reperfusion (Treatment in Cerebral Ischemia (TICI) 2c–3) and first pass effect (FPE, defined as TICI 2c–3 in a single pass). Secondary outcomes were 3 month functional independence (modified Rankin Scale score of 0–2), mortality, procedural complications, embolic complications, and symptomatic intracranial hemorrhage (SICH). A meta-analysis was performed using RevMan 5,4, and heterogeneity was assessed using the I2 test.ResultsOf 1629 studies identified, five articles with 2091 patients were included. For the primary outcomes, FPE (44.9% vs 45.4%, OR 1.04 (95% CI 0.90 to 1.22), I2=57%) or final successful reperfusion (64.5% vs 68.6%, OR 0.98 (95% CI 0.81% to 1.20%), I2=85%) was similar between the combination technique and stent retriever only groups. However, the combination technique had significantly less rescue treatment (18.8% vs 26.9%; OR 0.70 (95% CI 0.54 to 0.91), I2=0%). This did not translate into significant differences in secondary outcomes in functional outcomes, mortality, emboli, complications, or SICH.ConclusionThere was no significant difference in successful reperfusion and FPE between the combined techniques and the stent retriever and BGC alone groups. Neither was there any difference in functional outcomes, complications, or mortality.

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“…In another study, addition of distal aspiration catheters to BGC and SR thrombectomy did not result in higher rates of FPE or improved clinical outcomes. 38 In refractory occlusions of large vessels, a novel double-stent retriever technique has also been proposed. In this approach, standard stent retriever-based thrombectomy techniques are used, however, a second stent retriever is deployed either within or in parallel to the first stent and thrombectomy performed to retrieve the refractory clots.…”

Section: Discussionmentioning

confidence: 99%

A review of mechanical thrombectomy techniques for acute ischemic stroke

et al. 2022

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Mechanical thrombectomy is established as standard of care in the management of acute ischemic stroke due to large vessel occlusion and evidence-based guidelines for mechanical thrombectomy have been defined. As research continues to further expand the eligibility criteria for thrombectomy and the number of thrombectomy procedures increase worldwide, there is also growing focus on innovation of thrombectomy devices, procedural techniques, and related outcomes. Thrombectomy primarily involves use of stent retrievers and distal aspiration techniques, but variations and different combinations of techniques have been reported. As this is a rapidly evolving area in stroke management, there is debate as to which, if any, of these techniques leads to improved clinical outcomes over another and there is a lack of data comparing them. In this review, currently published and distinct techniques of mechanical thrombectomy are described methodically along with illustrations to aid in understanding the subtle differences between the techniques. The perceived benefits of each variation are discussed.

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Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke

Cited by 12 publications

References 28 publications

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis

A review of mechanical thrombectomy techniques for acute ischemic stroke

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