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

Huo, Xiaochuan; Sun, Dapeng; Hu, Mingkai; Raynald, -; Jia, Baixue; Tong, Xu; Ma, Gaoting; Wang, Anxin; Ma, Ning; Gao, Feng; Mo, Dapeng; Miao, Zhongrong

doi:10.1136/svn-2022-001765

Cited by 5 publications

(15 citation statements)

References 32 publications

(74 reference statements)

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“…The aspiration catheter was not widely used throughout China between 2017 and 2019; interventionists preferred to use the SR alone for the first-line EVT procedure during this study period. 43 Limitations of our study include the lack of core lab evaluation for TICI grade scaling after EVT. Moreover, precise information concerning the CA and SR devices (manufacturer, length, diameters) were not included in our analysis.…”

Section: Discussionmentioning

confidence: 98%

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Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study

Bourcier¹,

Consoli

Desilles

et al. 2023

European Stroke Journal

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Background: Technical improvements in devices, changes in angiographic grading scales and various confounding factors have made difficult the detection of the temporal evolution of angiographic and clinical results after endovascular treatment (EVT) for acute ischemic Stroke (AIS). We analyzed this evolution in time using the Endovascular Treatment in Ischemic Stroke (ETIS) registry. Materials and Methods: We analyzed the efficacy outcomes of EVT performed from January 2015 to January 2022, and modelized the temporal trends using mixed logistic regression models, further adjusted for age, intravenous thrombolysis prior to EVT, general anesthesia, occlusion site, balloon catheter use and the type of first-line EVT strategy. We assessed heterogeneity in temporal trends according to occlusion site, balloon catheter use, cardio embolic etiology, age (<80 years vs ⩾80 years) and first-line EVT strategy. Results: Among 6104 patients treated from 2015 to 2021, the rates of successful reperfusion (71.1%–89.6%) and of complete first pass effect (FPE) (4.6%–28.9%) increase, whereas the rates of patients with >3 EVT device passes (43.1%–17.5%) and favorable outcome (35.8%–28.9%) decrease significantly over time. A significant heterogeneity in temporal trends in successful reperfusion according to the first-line EVT strategy was found (p-het = 0.018). The temporal trend of increasing successful reperfusion rate was only significant in patients treated with contact aspiration in first-line (adjusted overall effect p = 0.010). Conclusion: In this 7-year-old large registry of ischemic stroke cases treated with EVT, we observed a significant increase with time in the rate of recanalization whereas there was a tendency toward a decrease in the rate of favorable outcome over the same period.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study

Bourcier¹,

Consoli

Desilles

et al. 2023

European Stroke Journal

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“…4 Similar results were reported when CoT and standalone SR were compared although the reported FPE rates were controversial. 5,6 Indeed, while Okuda et al 11 observed higher FPE rates with CoT compared with SR, Huo et al 12 showed that a higher number of passes and longer procedure times were associated with the use of CoT compared with SR alone. In our subgroup analysis, we did not find any difference between the 2 techniques in terms of FPE, but, interestingly, we showed significantly better results of CoT over SR alone in ICA terminus±M1-MCA occlusions considering eTICI ≥2b50 and eTICI ≥2c at the end of the first-line strategy.…”

Section: Discussionmentioning

confidence: 99%

“…No significant differences were reported about intraprocedural complications when the 3 techniques were compared. 4,5,11,12 ICA Terminus: A Location for New Devices and Techniques?…”

Section: Cot Versus Ca and Srmentioning

confidence: 99%

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Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial

Sgreccia,

Desilles,

Costalat

et al. 2024

Stroke

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BACKGROUND: The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions. METHODS: Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III (European Cooperative Acute Stroke Study) grades, and 3-month modified Rankin Scale). RESULTS: Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32–60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39–11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA. CONCLUSIONS: First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03290885.

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Robust Collaterals Are Independently Associated With Excellent Recanalization in Patients With Large Vessel Occlusion Causing Acute Ischemic Stroke

Yedavalli,

Koneru,

Hoseinyazdi

et al. 2024

SVIN

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Background In patients with acute ischemic stroke secondary to large vessel occlusion, achieving modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 (excellent recanalization) over mTICI 2b is associated with improved functional outcomes. We aimed to determine pretreatment and interventional parameters that are independently associated with mTICI 2c/3 over 2b reperfusion in patients who underwent technically successful mechanical thrombectomy. Methods In this retrospective study, consecutive patients with acute ischemic stroke with anterior circulation large vessel occlusion achieving mTICI 2b/2c/3 recanalization after mechanical thrombectomy were included. We evaluated the association between pretreatment clinical, imaging, and interventional parameters in patients who achieved mTICI 2c/3 versus 2b using multivariate logistic regressions. Results From May 11, 2019 to October 9, 2022, 149 consecutive patients met our inclusion criteria (median 70 years old [interquartile range 65–78.5], 57.7% female). Adjusted multivariate regression analyses showed that patients with excellent recanalization had lower admission National Institutes of Health Stroke Scale scores (adjusted odds ratio [aOR], 0.93; P =0.036), were less likely to have a history of diabetes (aOR, 0.42; P =0.050) and prior stroke (aOR, 0.27; P =0.007), had a cerebral blood volume index ≥0.7 (aOR, 3.75; P =0.007), and were more likely to achieve excellent recanalization with aspiration alone (aOR, 2.89; P =0.012). A multivariate logistic regression model comprising these independent factors predicted mTICI 2c/3 with an area under the curve 0.79 (95% CI, 0.68–0.86; P <0.001), sensitivity of 94%, and specificity of 41%. Conclusion Robust collateral status defined by cerebral blood volume index ≥0.7 on pretreatment computed tomography perfusion, absence of prior stroke, and absence of diabetes are independently associated with excellent recanalization in patients with successfully recanalized acute ischemic stroke‐large vessel occlusion. Our findings highlight the prognostic implications of robust collateral status and modifiable risk factors that may influence collateral status for maximizing the likelihood of excellent recanalization.

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

Cited by 5 publications

References 32 publications

Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study

Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study

Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial

Robust Collaterals Are Independently Associated With Excellent Recanalization in Patients With Large Vessel Occlusion Causing Acute Ischemic Stroke

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