Thrombectomy With Contact Aspiration and Stent Retriever vs. Stent Retriever Alone

Sep 29, 2021
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Authors:
Lapergue B, Blanc R, Costalat V, et al., on behalf of the ASTER2 Trial Investigators.
Citation:
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: The ASTER2 Randomized Clinical Trial. JAMA 2021;326:1158-1169.
Summary By:
Mollie McDermott, MD, MS

Quick Takes

  • The extent of radiographic reperfusion after mechanical thrombectomy in large vessel occlusion stroke is a strong predictor of a positive clinical outcome.
  • This trial investigated whether treatment with a stent retriever approach plus contact aspiration resulted in better radiographic outcomes than with a stent retriever approach alone.
  • No differences were observed in the major radiographic, clinic, or safety outcomes between the two arms.
  • The results of this trial are unlikely to change the current practice of neurointerventionalists.

Study Questions:

In the setting of anterior circulation large vessel occlusion (LVO) stroke, does using a stent retriever with contact aspiration result in a better radiographic outcome than using a stent retriever alone?

Methods:

ASTER2 is a 1:1 randomized open-label trial with blinded endpoints that enrolled patients at 11 sites in France. Eligible patients had an anterior circulation LVO and could be treated within 8 hours of last known normal. The intervention group received mechanical thrombectomy with contact aspiration and stent retriever as the initial intervention. The control group received mechanical thrombectomy with stent retriever alone as the initial intervention. The primary outcome was defined as the percentage of patients with a final thrombolysis in cerebral infarction (TICI) scale score of near-total reperfusion (TICI 2c) or total reperfusion (TICI 3).

Results:

Two hundred and three patients were randomized to the intervention group and 202 to the control group. No difference was observed in the primary outcome (64.5% in the intervention group vs. 57.9% in the control group; adjusted odds ratio, 1.33; 95% confidence interval, 0.88-1.99). No differences were observed in functional independence between the groups. No differences were observed in occurrence of intracerebral hemorrhage at 24 hours or in mortality at 90 days. No significant differences in procedure times were observed.

Conclusions:

A combined approach to mechanical thrombectomy using a stent retriever approach plus contact aspiration did not result in an increase in near-total or total radiographic reperfusion compared to stent retriever alone in acute stroke patients with anterior circulation LVO.

Perspective:

The results of this trial are unlikely to change the current practice of neurointerventionalists. Those who favor stent retriever technique alone will point to the lack of superior radiographic or clinical outcomes in the combined arm as justification for continuing with their current approach. Those who favor combined stent retriever technique with contact aspiration will point to the similarity in safety outcomes as justification for continuing with their current approach.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Interventions and Vascular Medicine, Nuclear Imaging

Keywords: Brain Ischemia, Cerebral Infarction, Coronary Occlusion, Functional Status, Hemorrhagic Stroke, Ischemic Stroke, Myocardial Revascularization, Radiography, Interventional, Reperfusion, Secondary Prevention, Stents, Stroke, Thrombectomy, Thrombolytic Therapy, Vascular Diseases


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