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Multicenter Study
. 2025 Jan 17;17(2):128-138.
doi: 10.1136/jnis-2023-021126.

Technique and impact on first pass effect primary results of the ASSIST global registry

Rishi Gupta  1 , Salvador Miralbés  2 , Angel Calleja Bonilla  2 , Bharath Naravetla  3 , Aniel Q Majjhoo  3 , Mahmoud Rayes  3 , Alejandro M Spiotta  4 , Christian Loehr  5 , Andreea Cioltan  5 , Dominik F Vollherbst  6 , Mario Martínez-Galdámez  7   8 , Jorge Galván-Fernandez  7 , Ahmad Khaldi  9 , Ryan A McTaggart  10 , Mahesh V Jayaraman  11 , Luc Defreyne  12 , Elisabeth Dhondt  12 , Pedro Vega  13 , Eduardo Murias  13 , Eugene Lin  14 , Varun Chaubal  14 , Lori Lyn Price  15 , David S Liebeskind  16 , Markus A Möhlenbruch  6 ; ASSIST Investigators
Affiliations
Multicenter Study

Technique and impact on first pass effect primary results of the ASSIST global registry

Rishi Gupta et al. J Neurointerv Surg. .

Abstract

Background: Patients treated with mechanical thrombectomy (MT) for acute ischemic strokes from large vessel occlusion (LVO) have better outcomes with effective reperfusion. However, it is unknown which technique leads to better technical and clinical success. We aimed to determine which technique yields the most effective first pass reperfusion during MT.

Methods: In a prospective, multicenter global registry we enrolled patients treated with operator preferred MT technique at 71 hospitals from January 2019 to January 2022. Three techniques were assessed: SR Classic with stent retriever (SR) and balloon guide catheter (BGC); SR Combination which employed SR with contact aspiration with or without BGC; and direct aspiration (DA) with or without BGC. The primary outcome was achieving an expanded Thrombolysis In Cerebral Infarction (eTICI) score of 2c or 3 on the first pass, with the primary technique as adjudicated by core lab. The primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2.

Results: A total of 1492 patients were enrolled. Patients treated with SR Classic or SR Combination were more likely to achieve first pass eTICI 2c or 3 reperfusion (P=0.01). There was no significant difference in mRS 0-2 (P=0.46) or safety endpoints.

Conclusions: The use of SR Classic or SR Combination was more likely to achieve first pass eTICI 2c or 3 reperfusion. There were no significant differences in clinical outcomes and safety endpoints.

Keywords: Stent; Stroke; Technique; Thrombectomy.

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Conflict of interest statement

Competing interests: RG serves as Principal Investigator (PI) for the ASSIST Registry (Stryker), PI for the RECCLAIM II Study (Zoll), Clinical Events Committee (CEC) for the MIND Trial (Penumbra), Data Safety Monitoring Board (DSMB) Membrane Study (Cerenovus), ELEVATE Study (Medtronic) consultant and stock options for Vesalio, Rapid Medical. AM serves as a consultant for Stryker. AS received research grants from Penumbra, Stryker, Medtronic, Avail, Rapid AI, Brain Aneurysm Foundation, consultant for Penumbra, Stryker, Terumo, RAPID AI, DSMB Brain Aneurysm Foundation, Stock options for Avail. CL is a consultant for Penumbra, Phenox, Stryker. DV received a research grant from Microvention, is a consultant for Medtronic, receives payment or honoraria for lectures from Cerenovus, travel support from Microvention and Medtronic. LD is a consultant for Stryker. LLP is an employee of Stryker and holds Stryker stock. LD is a consultant for Cerenovus, Genentech, Medtronic, Rapid Medical, Stryker, and Vesalio. MM received research grants from Acandis, Balt, Medtronic, Microvention, Phenox, Stryker* (*industry payments are made to the research fund of the institution), receives payment or honoraria for lectures from Balt, Medtronic, Stryker* (*industry payments are made to the research fund of the institution).

Figures

Figure 1
Figure 1. Survival analysis time to failure. Direct Asp, direct aspiration; SR, stent retriever.
See this image and copyright information in PMC

References

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