Title :

Susceptibility vessel sign in the aster trial: higher recanalization rate and more favourable clinical outcome after first line stent retriever compared to contact aspiration

Author(s) :

Bourcier, Romain [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Mazighi, Mikael [Auteur]
Fondation Ophtalmologique Adolphe de Rothschild [Paris]
Labreuche, Julien [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Fahed, Robert [Auteur]
Fondation Ophtalmologique Adolphe de Rothschild [Paris]
Blanc, Raphael [Auteur]
Fondation Ophtalmologique Adolphe de Rothschild [Paris]
Gory, Benjamin [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Duhamel, Alain [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Marnat, Gaultier [Auteur]
Centre Hospitalier Universitaire de Bordeaux [CHU Bordeaux]
Saleme, Suzana [Auteur]
Service de Neuroradiologie interventionnelle [CHU Limoges]
Costalat, Vincent [Auteur]
Université de Montpellier [UM]
Bracard, Serge [Auteur]
Université Henri Poincaré - Nancy 1 [UHP]
Desal, Hubert [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Consoli, Arturo [Auteur]
Université de Versailles Saint-Quentin-en-Yvelines [UVSQ]
Piotin, Michel [Auteur]
Fondation Ophtalmologique Adolphe de Rotschild
Lapergue, Bertrand [Auteur]
Université de Versailles Saint-Quentin-en-Yvelines [UVSQ]

Journal title :

Journal of stroke

Abbreviated title :

J Stroke

Volume number :

20

Pages :

268-276

Publication date :

2018-06-29

ISSN :

2287-6391

English keyword(s) :

Thrombectomy
Thrombosis
Retrieval device
Aspiration catheter

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Background and Purpose In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of ...
Show more >Background and Purpose In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) was studied to determine its influence on trial results. Methods We included patients having undergone CA or SR for M1 or M2 occlusions, who were screened by MRI with T2* gradient recalled echo. Occlusions were classified as SVS (+) or SVS (-) in each randomization arm. Modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3 revascularization rates were recorded and clinical outcomes assessed by the overall distribution of modified Rankin scale (mRS) at 90 days. Results Among the 202 patients included, 143 patients were SVS (+) (70.8%; 95% confidence interval [CI], 64.5% to 77.1%). Overall, there was no difference in angiographic and clinical outcomes according to SVS status. However, compared to SR, CA achieved a lower mTICI 2c/3 rate in SVS (+) patients (risk ratio [RR] for CA vs. SR, 0.60; 95% CI, 0.51 to 0.71) but not in SVS (-) (RR, 1.11; 95% CI, 0.69 to 1.77; P for interaction=0.018). A significant heterogeneity in favor of superiority of first-line SR strategy in SVS (+) patients was also found regarding the overall mRS distribution (common odds ratio for CA vs. SR, 0.40 vs. 1.32; 95% CI, 0.21 to 0.74 in SVS (+) vs. 95% CI, 0.51 to 3.35 in SVS (-); P for interaction=0.038). Conclusions As a first line strategy, SR achieved higher recanalization rates and a more favourable clinical outcome at 3 months compared to CA when MRI shows SVS within the thrombus.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T16:48:58Z
2020-05-19T08:24:40Z