Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial
Alessandro Sgreccia, Jean-Philippe Desilles, Vincent Costalat, Cyril Dargazanli, Romain Bourcier, Guillaume Tessier, Aymeric Rouchaud, Suzana Saleme, Laurent Spelle, Jildaz Caroff, Gaultier Marnat, Xavier Barreau, Frédéric Clarençon, Eimad Shotar, François Eugene, Emmanuel Houdart, Benjamin Gory, François Zhu, Julien Labreuche, Michel Piotin, Bertrand Lapergue, Arturo Consoli, Raphael Blanc, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Robert Fahed, Georges Rodesch, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard, Francis Turjman, Paul Emile Labeyrie, Roberto Riva, Charbel Mounayer, Alain Bonafé, Omer Eker, Grégory Gascou, Serge Bracard, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Hubert Desal, B. Daumas-Duport, Jérome Berge, Lynda Djemmane, Alain Duhamel.- Advanced and Specialized Nursing
- Cardiology and Cardiovascular Medicine
- Neurology (clinical)
BACKGROUND:
The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (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) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions.
METHODS:
Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III (European Cooperative Acute Stroke Study) grades, and 3-month modified Rankin Scale).
RESULTS:
Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32–60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39–11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA.
CONCLUSIONS:
First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure.
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