Aspiration Versus Stent Retriever Thrombectomy for Posterior Circulation Stroke

Abstract

Background and Purpose: Whereas a clear benefit of endovascular treatment for anterior circulation stroke has been established, randomized trials assessing the posterior circulation have failed to show efficacy. Previous studies in anterior circulation stroke suggest that advanced thrombectomy devices were of great importance in achieving clinical benefit. Little is known about the effect of thrombectomy techniques on outcomes in posterior circulation stroke. In this study, we compare first-line strategy of direct aspiration to stent retriever thrombectomy for posterior circulation stroke. Methods: We analyzed data of patients with a posterior circulation stroke who were included in the Multicentre Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry between March 2014 and December 2018, a prospective, nationwide study, in which data were collected from consecutive patients who underwent endovascular treatment for ischemic stroke in the Netherlands. We compared patients who underwent first-line aspiration versus stent retriever thrombectomy. Primary outcome was functional outcome according to the modified Rankin Scale. Secondary outcomes were reperfusion grade, complication rate, and procedure duration. Associations between thrombectomy technique and outcome measures were estimated with multivariable ordinal logistic regression analyses. Results: Overall, 71 of 205 patients (35%) were treated with aspiration, and 134 (65%) with stent retriever thrombectomy. Patients in the aspiration group had a lower pc-ASPECTS on baseline computed tomography, and general anesthesia was more often applied in this group. First-line aspiration was associated with better functional outcome compared with stent retriever thrombectomy (adjusted common odds ratio for a 1-point improvement on the modified Rankin Scale 1.94 [95% CI, 1.03–3.65]). Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2B) was achieved more often with aspiration (87% versus 73%, P =0.03). Symptomatic hemorrhage rates were comparable (3% versus 4%). Procedure times were shorter in the aspiration group (49 versus 69 minutes P <0.001). Conclusions: In this retrospective nonrandomized cohort study, our findings suggest that first-line aspiration is associated with a shorter procedure time, better reperfusion, and better clinical outcome than stent retriever thrombectomy in patients with ischemic stroke based on large vessel occlusion in the posterior circulation.

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

“…Recent studies found similar results investigating different thrombectomy strategies in LVO stroke, 28,29 but also observed that contact aspiration may be more beneficial about procedural and clinical outcomes in the posterior circulation. 30,31 However, these results seem barley comparable to DMVOs, since most occlusions were proximally located in the basilar artery, and procedural aspects (eg, catheter-tip-clot contact) may be favoring aspiration thrombectomy in this particular large vessel segment.…”

Aspiration versus stent retriever for posterior circulation stroke: A meta‐analysis

“…Ten studies 25,28,29,31,33–37 recorded complications, while six did not. The pooled analysis showed that compared with stent retriever, aspiration had lower rates of complications (OR, 0.48; 95% CI [0.30, 0.76], p = 0.002; Figure 3A).…”

“…Our findings also confirmed that treatment with aspiration was a more secure method than the stent retriever. Among the 10 studies 25,28,29,31,33–37 that reported complications, nine studies favored aspiration therapy (except De La Riva et al 33 that favored stent retriever). However, except for the study by Abdelrady et al 37 none of the other eight studies showed a statistically significant difference in complications between the two devices.…”

Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy

“…Cohort data support such concerns. In the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) registry data including 205 patients with posterior circulation stroke, contact aspiration was associated with better functional outcomes than stent retrieval (adjusted common OR for a 1-point improvement on the mRS, 1.94; 95% CI, 1.03 to 3.65), with higher rates of successful reperfusion and shorter procedure time when used as a first-line strategy [ 95 ]. Furthermore, in the ETIS prospective multicenter registry regarding BAO patients, contact aspiration was a strong predictor of the first pass effect [ 96 ].…”