Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis

Pérez-García, Carlos; Rosati, Santiago; Gómez-Escalonilla, Carlos; Arrazola, Juan; López-Frías, Alfonso; González, Eva; Fondevila, Jon; Vega, Pedro; Murías, Eduardo; Jimenez-Gomez, Elvira; Rey, Isabel Bravo; Macho, Juan; Román, Luís San; Caamaño, Isabel Rodríguez; Paipa, Andrés; Remollo, Sebastián; Tejedor, Yeray Aguilar; Bermúdez-Coronel, Isabel; Moliner, Sarai; Pumar, José Manuel; Bashir, Saima; Puig, Josep; López-Rueda, Antonio; Blasco, Jordi; Nogueira, Raul G; Moreu, Manuel

doi:10.1136/neurintsurg-2021-017987

Cited by 5 publications

(10 citation statements)

References 28 publications

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“…There are several advantages to the use of combined techniques compared with single device techniques. First, SR allows distal capture of the thrombus while vacuum-assisted aspiration reaches the proximal side, allowing capture of the thrombus on both sides, thereby reducing the risk of thrombus fragmentation during thrombectomy ( 13 ). In addition, by capturing a portion of the SR through DAC, there is less contact between the SR and the artery wall, reducing radial and traction forces, and thus reducing the risk of vascular injury ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for acute multivessel occlusions with duplicated middle cerebral artery: A case report

et al. 2023

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Acute multivessel occlusions generally have multisite clot burden with lower successful reperfusion rates, and cerebrovascular anatomical variants increase the challenge of endovascular clot retrieval. We report a case of acute anterior multivessel occlusions patient with duplicated middle cerebral artery. Combined balloon guide catheter with stent retriever and aspiration approach has gained complete revascularization and good functional outcomes at 3 months follow-up.

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Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for acute multivessel occlusions with duplicated middle cerebral artery: A case report

et al. 2023

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“…A total of 7,320 patients from 16 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) studies (1 randomised controlled trial and 15 observational studies) were enrolled in this study, including 3,406 with combined stent retriever and contact aspiration and 3,914 with stenting alone. The characteristics of the demographics regarding the type of literature included in the study are shown in Table 1.…”

Section: Basic Characteristics Of the Research Objectmentioning

confidence: 99%

“…In the evaluation of first pass near-complete or complete recanalization rates, a total of eight (12,(18)(19)(20)(21)(22)(23)26) studies were included with high heterogeneity (I 2 = 79%, p < 0.0001). The combined stent retriever and contact aspiration (S + A) totaled 2,459, with 662 (26.9%, 662/2,459) patients with first pass nearcomplete or complete recanalization.…”

Section: Efficacy and Safetymentioning

confidence: 99%

“…In terms of the rate of near-complete recanalization or complete recanalization after the operation, a total of nine articles were included (12,15,(19)(20)(21)(22)(23)(24)27), with high heterogeneity (I 2 = 91%, p = 0.00001). A total of 2,118 persons were included in the S + A group, and 1,384 (65.3%, 1,384/2,118) were near-complete recanalization or complete recanalization of the vessels after the operation; a total of 1,584 persons were included in group S. Near-complete recanalization or complete recanalization of vessels after operation was achieved in 925 individuals (58.4%, 925/1,584).…”

Section: The Rate Of Near-complete or Complete Recanalization After O...mentioning

confidence: 99%

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Efficacy and safety of combined stent retriever and contact aspiration vs. stent retriever alone on revascularization in patients with acute ischemic stroke: a systematic review and meta-analysis

Li,

Lin,

et al. 2024

Front. Neurol.

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ObjectiveWhether the efficacy of combined stent retriever and contact aspiration (S + A) is superior to stent retriever (S) alone for revascularisation in patients with large vessel occlusive stroke remains uncertain. The aim of this meta-analysis was to assess the safety and efficacy of combined stent retriever and contact aspiration for the treatment of acute ischaemic stroke with large vessel occlusion by comparing it with stent retriever alone.MethodsWe systematically searched the PubMed, Embase, Web of Science, and The Cochrane Library databases for randomised controlled trials and observational studies (case-control and cohort studies) published before 1 October 2023 comparing the efficacy of combined stent retriever and contact aspiration versus tent retriever alone in patients with large vessel occlusive stroke. The end point of the primary efficacy observed in this meta-analysis study was the rate of first pass nearly complete or complete recanalisation (mTICI 2c-3). Secondary effectiveness nodes were: rate of first pass successful recanalisation (mTICI 2b-3), rate of near-complete or complete recanalisation of the postoperative vessel, rate of successful recanalisation of the postoperative vessel, and MRS 0–2 within 90 days. Safety endpoints were interoperative embolism, symptomatic intracranial haemorrhage, and mortality within 90 days.ResultsA total of 16 studies were included in the literature for this meta-analysis, with a total of 7,320 patients (S + C group: 3,406, S group: 3,914). A comprehensive analysis of the included literature showed that combined stent retriever and contact aspiration had a higher rate of near-complete or complete recanalisation of the postoperative vessel [OR = 1.53, 95% CI (1.24, 1.88), p < 0.0001] and rate of successful recanalisation of the postoperative vessel compared to stent retriever alone [OR = 1.83, 95% CI (1.55, 2.17), p < 0.00001]; there were no statistically significant differences between the two groups in terms of the rate of first pass nearly complete or complete recanalisation [OR = 1.00, 95% CI (0.83, 1.19), p = 0.96], rate of first pass successful recanalisation [OR = 1.02, 95% CI (0.85, 1.24), p = 0.81], interoperative embolism [OR = 0.93, 95% CI (0.72, 1.20), p = 0.56], symptomatic intracranial haemorrhage [OR = 1.14, 95% CI (0.87, 1.48), p = 0.33], MRS 0–2 within 90 days [OR = 0.89, 95% CI (0.76, 1.04), p = 0.14] and mortality within 90 days [OR = 1.11, 95% CI (0.94, 1.31), p = 0.22].ConclusionCombined stent retriever and contact aspiration has a higher rate of postprocedural revascularisation (mTICI 2c-3/mTICI 2b-3) compared with stent retriever alone in patients with large vessel occlusion stroke. In addition, it was not superior to stenting alone in terms of the rate of first pass recanalisation (mTICI 2c-3/mTICI 2b-3), interoperative embolisation, symptomatic intracranial haemorrhage, good functional prognosis within 90 days and mortality within 90 days.

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“…However, the navigation of the aspiration catheter through tortuous vessels such as the internal carotid artery (ICA) is a complex operation ( 14 ) and can occasionally result in vascular damage and post-surgery complications ( 15 ). There is debate in the literature on how to optimize the technique in these situations ( 16 ), namely, where is the best location to apply the suction ( 10 , 15 , 17 , 18 ) and what aspiration flow rate guarantees the best outcome.…”

Section: Introductionmentioning

confidence: 99%

A multiscale computational framework to evaluate flow alterations during mechanical thrombectomy for treatment of ischaemic stroke

Benemerito

Mustafa

Wang

et al. 2023

Front. Cardiovasc. Med.

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The treatment of ischaemic stroke increasingly relies upon endovascular procedures known as mechanical thrombectomy (MT), which consists in capturing and removing the clot with a catheter-guided stent while at the same time applying external aspiration with the aim of reducing haemodynamic loads during retrieval. However, uniform consensus on procedural parameters such as the use of balloon guide catheters (BGC) to provide proximal flow control, or the position of the aspiration catheter is still lacking. Ultimately the decision is left to the clinician performing the operation, and it is difficult to predict how these treatment options might influence clinical outcome. In this study we present a multiscale computational framework to simulate MT procedures. The developed framework can provide quantitative assessment of clinically relevant quantities such as flow in the retrieval path and can be used to find the optimal procedural parameters that are most likely to result in a favorable clinical outcome. The results show the advantage of using BGC during MT and indicate small differences between positioning the aspiration catheter in proximal or distal locations. The framework has significant potential for future expansions and applications to other surgical treatments.

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Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis

Cited by 5 publications

References 28 publications

Mechanical thrombectomy for acute multivessel occlusions with duplicated middle cerebral artery: A case report

Mechanical thrombectomy for acute multivessel occlusions with duplicated middle cerebral artery: A case report

Efficacy and safety of combined stent retriever and contact aspiration vs. stent retriever alone on revascularization in patients with acute ischemic stroke: a systematic review and meta-analysis

A multiscale computational framework to evaluate flow alterations during mechanical thrombectomy for treatment of ischaemic stroke

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