Technique and impact on first pass effect primary results of the ASSIST global registry

Abstract

BackgroundPatients treated with mechanical thrombectomy (MT) for acute ischemic strokes from large vessel occlusion (LVO) have better outcomes with effective reperfusion. However, it is unknown which technique leads to better technical and clinical success. We aimed to determine which technique yields the most effective first pass reperfusion during MT.MethodsIn a prospective, multicenter global registry we enrolled patients treated with operator preferred MT technique at 71 hospitals from January 2019 to January 2022. Three techniques were assessed: SR Classic with stent retriever (SR) and balloon guide catheter (BGC); SR Combination which employed SR with contact aspiration with or without BGC; and direct aspiration (DA) with or without BGC. The primary outcome was achieving an expanded Thrombolysis In Cerebral Infarction (eTICI) score of 2c or 3 on the first pass, with the primary technique as adjudicated by core lab. The primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0–2.ResultsA total of 1492 patients were enrolled. Patients treated with SR Classic or SR Combination were more likely to achieve first pass eTICI 2c or 3 reperfusion (P=0.01). There was no significant difference in mRS 0–2 (P=0.46) or safety endpoints.ConclusionsThe use of SR Classic or SR Combination was more likely to achieve first pass eTICI 2c or 3 reperfusion. There were no significant differences in clinical outcomes and safety endpoints.

Stent retriever versus aspiration based thrombectomy: impact on first pass reperfusion, procedure time, and clinical outcomes in large vessel occlusion. Nationwide registry based cohort study

“…No difference in total procedure time was found although aspiration based thrombectomy was faster in the FPR group. 6 In contrast with our results, previous studies have not found any association between the firstline method and clinical outcome in anterior circulation stroke. 5 10 However, most previous studies have been of limited size and/or designed as clinical trials, not necessarily reflecting the true clinical patient panorama.…”

“…Recent randomized studies have suggested that stent retriever and aspiration based thrombectomy perform similarly regarding the FPR rate while other observational studies have shown differences. [3][4][5][6] Further, there is no consensus on whether the methods differ in technical and clinical outcomes when FPR or MPR is achieved. 5 Experience of the operator might predict FPR, and the learning curve of the methods might differ, indicating that high volume center analysis is needed to compare true effects.…”

Placing the balloon-guide catheter in the high cervical segment of the internal carotid artery is associated with improved recanalization

“…This Registry aimed to assess the procedural success and clinical outcomes associated with various techniques for mechanical thrombectomy in LVO in the anterior circulation. 19 It included data from 1492 patients enrolled in 71 North American, European, and Asian centers from January 2019 to May 2022. See primary publication for further details.…”

“…See primary publication for further details. 19 Inclusion and exclusion criteria can be found in the supplement.…”

A Randomised Study Comparing First-line Dual Vs Single-Stentretriever Technique: TWIN2WIN

“…Unfortunately, currently available thrombectomy devices to date can only achieve FPR rates ranging from 30 to 60% 10,11,12 . The simultaneous double stent-retriever (double-SR) technique was first proposed as a rescue therapy after multiple failed attempts to retrieve a refractory thrombus with a single-SR 13,14 .…”