Equal performance of aspiration and stent retriever thrombectomy in daily stroke treatment

Marie Louise Elisabeth Bernsen* (Corresponding Author), Robert Jan Berend Goldhoorn, Robert J. Van Oostenbrugge, Wim H. Van Zwam, Maarten Uyttenboogaart, Yvo B.W.E.M. Roos, Jeannette Hofmeijer, Jasper M. Martens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)

Abstract

Background: Mechanical thrombectomy with stent retrievers has proved to be safe and effective in endovascular treatment of acute ischemic stroke. Direct aspiration has shown revascularization rates comparable to those of stent retrievers in the recent ASTER and COMPASS trials. However, the efficacy of aspiration in routine clinical practice has not yet been shown. Objective: To show that aspiration has clinical and technical outcomes equal to those of stent retriever thrombectomy in daily clinical practice. Methods: We analysed data of patients with a large vessel occlusion of the anterior circulation registered in the Dutch MR CLEAN Registry between March 2014 and June 2016. Primary outcome was functional outcome measured with the modified Rankin Scale (mRS) score. Secondary outcomes were reperfusion grade, periprocedural complication rate, and procedure duration. Association of treatment technique with functional outcome was estimated with univariable and multivariable ordinal logistic regression analysis and expressed as a common OR (cOR) for a shift towards better outcome on the mRS. Results: As first-line treatment, 207 of 1175 patients (17.6%) were treated with direct aspiration, and 968 (82.4%) by a stent retriever. We observed no differences in functional outcome (adjusted cOR=1.020 (95% CI 0.68 to 1.52)) and periprocedural complications. Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2b) was similar. Duration of the procedure was shorter with aspiration (57 min (IQR 35-73) vs 70 min (IQR 47-95), p<0.0001). Conclusion: Direct aspiration shows clinical outcomes equal to those of stent retriever thrombectomy in our large multicenter real-life cohort. We found no difference in complication rates and shorter procedure times for aspiration.

Original languageEnglish
Pages (from-to)631-636
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume11
Issue number7
Early online date24 Nov 2018
DOIs
Publication statusPublished - 17 Jun 2019
Externally publishedYes

Keywords

  • stroke
  • technique
  • thrombectomy
  • device

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    Bernsen, M. L. E., Goldhoorn, R. J. B., Van Oostenbrugge, R. J., Van Zwam, W. H., Uyttenboogaart, M., Roos, Y. B. W. E. M., ... Martens, J. M. (2019). Equal performance of aspiration and stent retriever thrombectomy in daily stroke treatment. Journal of NeuroInterventional Surgery, 11(7), 631-636. https://doi.org/10.1136/neurintsurg-2018-014270