Adding contact aspiration to stent retriever fails to improve reperfusion in stroke
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For patients with acute ischemic stroke due to large vessel occlusion, contact aspiration and stent retriever therapy did not improve the rate of near-total or total reperfusion compared with stent retriever alone, concluded new results.
The aim of the ASTER2 study, published in JAMA, was to assess whether mechanical thrombectomy with initial contact aspiration and stent retriever combined leads to a better final angiographic outcome than standard stent retriever alone for the treatment of anterior circulation large vessel occlusion stroke.
For the multicenter, randomized, open-label, blinded endpoint evaluation trial, Bertrand Lapergue, MD, PhD, of Hopital Foch in Suresnes, France, and colleagues enrolled 408 patients between October 16, 2017 and May 29, 2018 at 11 French comprehensive stroke centers. Patients had a large vessel occlusion in the anterior circulation up to 8 hours after symptom onset and were followed for 12 months.
Researchers randomly assigned patients 1:1 to receive initial thrombectomy with contact aspiration and stent retriever combined (n = 205) or stent retriever alone (n = 203).
The rate of expanded Thrombolysis In Cerebral Infarction score of 2c or 3 (eTICI 2c/3)—indicating near-total and total reperfusion grades—at the end of the procedure served as the primary outcome.
After excluding three patients, 405 (mean age, 73 years; 54% women) remained for the primary analysis.
According to the results, the primary outcome did not differ significantly between the thrombectomy groups (combination therapy, 64.5%; stent retriever alone, 57.9%; adjusted OR = 1.33; 95% CI, 0.88-1.99; P = .17).
Similarly, of the 14 prespecified secondary efficacy endpoints, all but two were statistically similar. The combination group had a higher rate of successful reperfusion (eTICI 2b50/2c/3: 86.2% vs. 72.3%; adjusted OR = 2.54; P < .001) and of near-total or total reperfusion (eTICI 2c/3: 59.6% vs. 49.5%; adjusted OR = 1.52; P = .04) after the assigned initial intervention alone.
In other data, the procedure times did not significantly vary between the procedures.
“The time initially gained by not navigating an aspiration catheter in the stent retriever group was subsequently lost by doing so for the second-line strategy, thus resulting in similar total procedure times between the stent retriever alone group and the stent retriever and contact aspiration combined group,” the researchers wrote. “These findings suggested that contact aspiration and stent retriever combined may be more efficient to obtain successful recanalization but that this effect disappeared after rescue therapy.”
The researchers concluded that, among patients with acute ischemic stroke due to large vessel occlusion, “an initial thrombectomy technique consisting of contact aspiration and stent retriever combined, compared with stent retriever alone, did not significantly improve the rate of near-total or total reperfusion (eTICI 2c/3) at the end of the endovascular procedure, although the trial may have been underpowered to detect smaller differences between groups.”
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