Aspiration Versus Stent‐Retriever as First‐Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity‐Score Matched Multicenter Analysis-Reference-Cited by-同舟云学术

Aspiration Versus Stent‐Retriever as First‐Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity‐Score Matched Multicenter Analysis

Published:2023-11 Issue:6 Volume:3 Page:
ISSN:2694-5746
Container-title:Stroke: Vascular and Interventional Neurology
language:en
Short-container-title:SVIN

Author:

Siegler James E.¹²,Shaikh Hamza¹²,Khalife Jane¹²,Oak Solomon²,Zhang Linda²,Abdalkader Mohamad³,Klein Piers³,Nguyen Thanh N.³,Kass‐Hout Tareq⁴,Morsi Rami Z.⁴,Heit Jeremy J.⁵,Regenhardt Robert W.⁶,Diestro Jose Danilo Bengzon⁷,Cancelliere Nicole M.⁷,Ghozy Sherief⁸,Sweid Ahmad³,Naamani Kareem El⁹,Amllay Abdelaziz⁹,Meyer Lukas¹⁰,Dusart Anne¹¹,Bellante Flavio¹¹,Forestier Géraud¹²,Rouchaud Aymeric¹²,Saleme Suzana¹²,Mounayer Charbel¹²,Fiehler Jens¹⁰,Kühn Anna Luisa¹³,Puri Ajit S.¹³,Dyzmann Christian¹⁴,Kan Peter T.¹⁵,Colasurdo Marco¹⁵,Marnat Gaultier¹⁶,Berge Jérôme¹⁶,Barreau Xavier¹⁶,Sibon Igor¹⁷,Nedelcu Simona¹⁸,Henninger Nils¹⁸¹⁹,Marotta Thomas R.⁷,Das Alvin S.²⁰,Stapleton Christopher J.⁶,Rabinov James D.⁶,Ota Takahiro²¹,Dofuku Shogo²¹,Yeo Leonard L.L.²²²³,Tan Benjamin Y.Q.²²²³,Martinez‐Gutierrez Juan Carlos²⁴,Salazar‐Marioni Sergio²⁴,Sheth Sunil A.²⁴,Renieri Leonardo²⁵,Capirossi Carolina²⁵,Mowla Ashkan²⁶,Tjoumakaris Stavropoula I.⁹,Jabbour Pascal⁹,Khandelwal Priyank²⁷,Biswas Arundhati²⁸,Clarençon Frédéric²⁹,Elhorany Mahmoud²⁹³⁰,Premat Kevin²⁹,Valente Iacopo³¹,Pedicelli Alessandro³¹,Filipe João Pedro³²,Varela Ricardo³³,Quintero‐Consuegra Miguel³⁴,Gonzalez Nestor R.³⁴,Möhlenbruch Markus A.³⁵,Jesser Jessica³⁵,Costalat Vincent³⁶,Schiphorst Adrien ter³⁷,Yedavalli Vivek³⁸,Harker Pablo³⁹,Chervak Lina M.³⁹,Aziz Yasmin³⁹,Bullrich Maria Bres⁴⁰,Sposato Luciano⁴⁰,Gory Benjamin⁴¹⁴²,Hecker Constantin⁴³,Killer‐Oberpfalzer Monika⁴³,Griessenauer Christoph J.⁴³,Thomas Ajith J.¹²,Hsieh Cheng‐Yang⁴⁴,Liebeskind David S.⁴⁵,Radu Răzvan Alexandru³⁶,Alexandre Andrea M.³¹,Tancredi Illario⁴⁶,Faizy Tobias D.¹⁰,Fahed Robert⁴⁷,Weyland Charlotte³⁵⁴⁸,Patel Aman B.⁶,Pereira Vitor Mendes⁷,Lubicz Boris⁴⁶,Guenego Adrien⁴⁶,Dmytriw Adam A.⁶⁷^ORCID,

Affiliation:

1. Cooper Neurological Institute Cooper University Hospital Camden New Jersey USA

2. Cooper Medical School of Rowan University Camden New Jersey USA

3. Departments of Radiology & Neurology Boston Medical Center Boston Massachusetts USA

4. Department of Neurology University of Chicago Chicago Illinois USA

5. Department of Interventional Neuroradiology Stanford Medical Center Palo Alto California USA

6. Neuroendovascular Program Massachusetts General Hospital Harvard University Boston Massachusetts USA

7. Division of Diagnostic and Therapeutic Neuroradiology Department of Medical Imaging St. Michael's Hospital University of Toronto Toronto Canada

8. Department of Radiology Mayo Clinic Rochester Minnesota USA

9. Department of Neurosurgery Thomas Jefferson University Philadelphia Pennsylvania USA

10. Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg Germany

11. Department of Neurology Hôpital Civil Marie Curie Charleroi Belgium

12. University Hospital of Limoges Neuroradiology Department Dupuytren Université de Limoges XLIM CNRS UMR 7252 Limoges France

13. Division of Neurointerventional Radiology Department of Radiology University of Massachusetts Medical Center Worcester Massachusetts USA

14. Neuroradiology Department Sana Kliniken Lübeck GmbH Lübeck Germany

15. Department of Neurosurgery University of Texas Medical Branch Galveston Texas USA

16. Interventional Neuroradiology Department Bordeaux University Hospital Bordeaux France

17. Neurology Department Bordeaux University Hospital Bordeaux France

18. Department of Neurology University of Massachusetts Chan Medical School Worcester Massachusetts USA

19. Department of Psychiatry University of Massachusetts Chan Medical School Worcester Massachusetts USA

20. Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA

21. Department of Neurosurgery Tokyo Metropolitan Tama Medical Center Tokyo Japan

22. Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore

23. Division of Neurology Department of Medicine National University Hospital Singapore Singapore

24. Department of Neurology UTHealth McGovern Medical School Houston Texas USA

25. Interventistica Neurovascolare Ospedale Careggi di Firenze Florence Italy

26. Division of Stroke and Endovascular Neurosurgery Department of Neurological Surgery Keck School of Medicine University of Southern California (USC) Los Angeles California USA

27. Department of Endovascular Neurosurgery and Neuroradiology NJMS Newark New Jersey USA

28. Department of Neurosurgery Westchester Medical Center at New York Medical College Valhalla New York USA

29. Department of Neuroradiology Pitié‐Salpêtrière Hospital, GRC BioFast, Sorbonne University, Paris VI Paris France

30. Neurology Department Faculty of Medicine Tanta University Tanta Egypt

31. UOSA Neuroradiologia Interventistica Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Florence Italy

32. Department of Diagnostic and Interventional Neuroradiology Centro Hospitalar Universitário do Porto Porto Portugal

33. Department of Neurology Centro Hospitalar Universitário do Porto Porto Portugal

34. Department of Neurosurgery Cedars‐Sinai Medical Center Los Angeles California USA

35. Sektion Vaskuläre und Interventionelle Neuroradiologie Universitätsklinikum Heidelberg Heidelberg Germany

36. Department of Neuroradiology Gui de Chauliac Hospital Montpellier University Medical Center Montpellier France

37. Department of Neurology Gui de Chauliac Hospital Montpellier University Medical Center Montpellier France

38. Department of Radiology Division of Neuroradiology Johns Hopkins Medical Center Baltimore Maryland USA

39. Department of Neurology University of Cincinnati Medical Center Cincinnati Ohio USA

40. Departments of Medical Imaging & Neurology LHSC University Hospital London Ontario Canada

41. Department of Interventional Neuroradiology Nancy University Hospital Nancy France

42. INSERM U1254 IADI Université de Lorraine Vandoeuvre‐les‐Nancy Limoges France

43. Departments of Neurology & Neurosurgery Christian Doppler Clinic Paracelsus Medical University Salzburg Salzburg Austria

44. Neurology Department Sin‐Lau Hospital Tainan Taiwan

45. UCLA Stroke Center and Department of Neurology Department UCLA Los Angeles California USA

46. Department of Diagnostic and Interventional Neuroradiology Erasme University Hospital Brussels Belgium

47. Department of Medicine Division of Neurology The Ottawa Hospital Ottawa Hospital Research Institute and University of Ottawa Ottawa Ontario Canada

48. Department of Neuroradiology University Hospital RWTH Aachen Germany

Abstract

Background For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry. Methods Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups. Results Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P <0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P =0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P =0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98]; P =0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09]; P =0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18]; P =0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models. Conclusion In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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