Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion

Mechanical thrombectomy using a stent retriever or contact aspiration is widely used for treatment of patients with acute ischemic stroke due to anterior circulation large vessel occlusion, but the additional benefit of combining contact aspiration with stent retriever is uncertain.

Several randomized clinical trials (RCTs) have demonstrated that endovascular mechanical thrombectomy leads to a better functional outcome compared with medical therapy in patients with acute ischemic stroke due to large vessel occlusion. Mechanical thrombectomy strategies encompass the use of second-generation devices such as stent retrievers or contact aspiration catheters as an initial therapy for stroke. Reperfusion is a strong predictor of clinical outcome and, to date, whatever the technique used as the initial approach (contact aspiration or stent retriever thrombectomy), the rate of good reperfusion, corresponding with a total score of on the expanded Thrombolysis In Cerebral Infarction scale (eTICI 3; score indicates complete perfusion) or near-total (eTICI 2c; score indicates near-complete perfusion ) reperfusion scores, remains below 60%.2-4 Both European and US recommendations propose that clinical trials be conducted to determine the best strategy of mechanical thrombectomy device uses that achieve the highest rate of successful reperfusion. The concomitant use of contact aspiration during stent retriever thrombectomy (combination of contact aspiration and stent retriever) has been proposed as a more efficient technique to achieve a higher rate of reperfusion due to the potential synergistic effect of the 2 techniques used simultaneously. Nevertheless, this potential synergistic effect of contact aspiration and stent retriever devices in initial mechanical thrombectomy remains uncertain and needs to be evaluated in a head-to-head RCT. This present RCT aimed to test whether combining contact aspiration and stent retriever techniques improves the rate of eTICI 2c/3 reperfusion at the end of the procedure when compared with stent retriever alone as an initial thrombectomy strategy in patients undergoing endovascular treatment for large vessel occlusion. Read more...

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