Immediate effects of first-line thrombectomy devices for intracranial atherosclerosis-related occlusion: stent retriever versus contact aspiration
Open Access
- 18 July 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Neurology
- Vol. 20 (1), 1-10
- https://doi.org/10.1186/s12883-020-01862-6
Abstract
Although stent retriever (SR) is recommended as a frontline device of endovascular treatment (EVT) for embolic large artery occlusion causing acute ischemic stroke, contact aspiration (CA) device showed similar efficacy in the recent trials. However, the efficacy of the both devices as first-line therapy for intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion has not yet been established. Therefore, we compared the immediate effects and final outcomes of SR and CA as first-line devices for treating ICAS-related occlusions. We retrospectively analyzed the data of patients who underwent EVT for acute ischemic stroke from the registry of three Korean hospitals. Patients with ICAS-related occlusion who were treated within 24 h of onset of the symptoms were included. We investigated immediate reperfusion performance, immediate safety outcomes, and 3-month clinical outcomes for the two first-line devices. Of the 720 registered patients, 111 were eligible for this study. Forty-nine patients (44.1%) used SR and 62 (55.9%) used CA as the first-line device. Achieving successful reperfusion immediately after first-line thrombectomy was more frequent in the SR group than that in the CA group (77.6% vs. 43.5%, p = 0.001), with fewer additional rescue treatments (12.2% vs. 59.7%, p < 0.001). The incidence of iatrogenic dissection or rupture was lower in the SR group than that in the CA group (8.2% vs. 29.0%, p = 0.012). After additional rescue treatments, however, the final successful reperfusion rate did not differ between the two groups (SR 87.8% vs. CA 77.4%, p = 0.247), and there was no significant difference in the 3-month good outcomes (modified Rankin Scale, p = 0.524). First-line SR thrombectomy showed higher immediate reperfusion and less vessel injury for ICAS-related occlusions than CA. However, there was no significant difference in the final reperfusion status or 3-month outcomes from additional rescue treatments.Keywords
Other Versions
Funding Information
- National Research Foundation of Korea Grant (NRF-2018R1A2B6007094, MSIP No. 2014R1A5A2010008)
This publication has 34 references indexed in Scilit:
- Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular TreatmentJournal of Stroke, 2018
- Predictive Value of Computed Tomography Angiography–Determined Occlusion Type in Stent Retriever ThrombectomyStroke, 2017
- Medical Treatment of Intracranial Atherosclerosis: An UpdateJournal of Stroke, 2017
- First-line use of contact aspiration for thrombectomy versus a stent retriever for recanalization in acute cerebral infarction: The randomized ASTER study protocolInternational Journal of Stroke, 2017
- Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar OcclusionAmerican Journal of Neuroradiology, 2016
- Histological examination of vascular damage caused by stent retriever thrombectomy devicesJournal of NeuroInterventional Surgery, 2015
- Research on Intracranial Atherosclerosis from the East and West: Why Are the Results Different?Journal of Stroke, 2014
- Stenting versus Aggressive Medical Therapy for Intracranial Arterial StenosisThe New England Journal of Medicine, 2011
- Prediction of Symptomatic Vasospasmafter Subarachnoid Hemorrhage: The Modified Fisher ScaleNeurosurgery, 2006
- Hemorrhagic Transformation Within 36 Hours of a Cerebral InfarctStroke, 1999