Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry

Abstract

Background and purpose: An analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion (LVO) stroke between stent retrieval (SR) alone as a first-line mechanical thrombectomy (MT) technique (SR alone first-line) and concomitant use of contact aspiration (CA) plus SR as a first-line MT technique (SR+CA first-line). The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.

Methods: We conducted the present study by using the data from the ANGEL-ACT registry. We divided the selected patients into SR+CA first-line and SR alone first-line groups. We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes, including successful/complete recanalisation after the first technique alone and all procedures, first-pass successful/complete recanalisation, number of passes, 90-day modified Rankin Scale, procedure duration, rescue treatment and intracranial haemorrhage within 24 hours.

Results: Of the 1233 enrolled patients, 1069 (86.7%) received SR alone first-line, and 164 (13.3%) received SR+CA first-line. SR+CA first-line was associated with more thrombectomy passes (3 (2-4) vs 2 (1-2); β=1.77, 95% CI=1.55 to 1.99, p<0.001), and longer procedure duration (86 (60-129) min vs 80 (50-122) min; β=10.76, 95% CI=1.08 to 20.43, p=0.029) than SR alone first-line group. Other outcomes were comparable (all p>0.05) between the two groups.

Conclusions: Patients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line. Additionally, we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level, first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

Keywords: Stroke; Thrombectomy.

Figure 1

Flow chart of patient selection. ACA, anterior cerebral artery; CA, contact aspiration; EVT, endovascular thrombectomy; IAT, intra-arterial thrombolysis; mRS, modified Rankin Scale; PCA, posterior cerebral artery; SR, stent retriever.

Figure 2

Treatment effects on the primary outcome according to exploratory subgroups. ^aAdjusted for the propensity score. CA, contact aspiration; ICAD, intracranial atherosclerotic disease; IVT, intravenous thrombolysis; NIHSS, National Institutes of Health Stroke Scale; SR, stent retriever; TOAST, Trial of ORG 10172 in Acute Stroke Treatment criteria.