Contact aspiration comparable to stent retriever as frontline thrombectomy for acute ischaemic stroke
Contact aspiration is comparable to stent retriever (SR) as frontline thrombectomy for patients with acute ischaemic stroke resulting from large vessel occlusion (LVO), according to the ASTER* trial presented at the recent International Stroke Conference (ISC 2017) held in Texas, Houston, US.
The current gold standard for treating ischaemic stroke with LVO is mechanical thrombectomy (MT) with a SR, in association with recombinant tissue plasminogen activator, according to study scientific coordinator Dr Bertrand Lapergue from the Foch Hospital and Versailles Saint Quentin en Yvelines University in Suresnes, France.
“The ASTER trial is the first independent and large randomized controlled trial focusing on a new strategy and comparing it with the gold standard,” said Lapergue, who noted that new MT technique such as contact aspiration had appeared promising in increasing reperfusion status, which has been associated with favourable clinical outcome in retrospective studies.
The prospective, multicentre, open-label study randomized 380 patients with suspected ischaemic anterior circulation stroke resulting from LVO who had symptom onset within 6 hours to receive treatment with SR or contact aspiration/ADAPT**. Treatment was continued with another approach at the operator’s discretion after three failed attempts with the assigned technique. Patients with posterior circulation stroke and cervical carotid artery occlusion were excluded. [ISC 2017, abstract LB2]
After the total endovascular procedure, both the contact aspiration and SR groups showed similar rates of successful reperfusion, as indicated by a modified Thrombolysis In Cerebral Infarction (mTICI) score of 2b–3 (85.4 percent vs 83.1 percent, odds ratio [OR], 1.2; p=0.53). Full perfusion (mTICI 3) rates were also similar in both arms (37.5 percent vs 38.6 percent, OR, 0.95; p=0.82).
Also, the rates of successful reperfusion (63 percent vs 67.7 percent, OR, 0.81; p=0.33) and full reperfusion (28.6 percent vs 35.4 percent, OR, 0.73; p=0.15) after the assigned frontline strategy alone were comparable in both treatment arms.
However, more patients in the contact aspiration arm required a rescue therapy compared with the SR arm (32.8 percent vs 23.8 percent, OR, 1.56; p=0.053).
In terms of safety endpoints, there were no significant differences in postprocedural complications such as new embolization (3.6 percent vs 2.6 percent; p=0.75), arterial dissection (2.6 percent vs 1.1 percent; p=0.37), and arterial perforation (2.6 percent vs 1.6 percent; p=0.69).
Additionally, no differences were observed for symptomatic intracranial haemorrhage rates at day 1 (5.2 percent vs 6.3 percent; p=0.63) and new infarct rates at day 1 (5.3 percent vs 8.5 percent; p=0.22) between the two groups.
“[The] ASTER trial opens the door to add a new tool (ADAPT) to remove the clot,” said Lapergue.
“The ADAPT technique offers the possibility to easily add a SR following … aspiration if needed, leading to time saving,” added study principal investigator Dr Michel Piotin of the Rothschild Foundation Hospital in Paris, France.