Résumé
Abstract only Purpose: The ASTER trial (contact Aspiration versus Stent Retriever for revascularization in patients presenting with acute ischemic stroke and a large vessel occlusion in the anterior circulation within six hours of symptom onset) did not show superiority of contact aspiration over stent retriever regarding successful revascularization (TICI 2B/3) result at the end of the procedure and clinical results at 3 months. Objective: To assess whether patient admission modes, directly to a comprehensive stroke center (CSC) versus to a primary stroke center (PSC), impacted the rate of patients with functional independence at 3 months and the rate of favorable angiographic outcome in the ASTER trial. Methods: Primary outcomes included degree of functional independence (modified Rankin scale ≤2) at 90 days, the change in National Institute of Health Stroke Scale (NIHSS) at 24 hours, all-cause mortality at 90 days, and procedure-related serious adverse events. Secondary outcome was the proportion of patients with successful revascularization defined as a modified Thrombolysis In Cerebral Infarction [mTICI] score of 2b or 3 at the end of procedure. Results: Among 381 patients who were randomized in the ASTER trial, 138 were directly admitted to a CSC (Mothership paradigm) and 243 were admitted first in a PSC (Drip-and-Ship paradigm). Aspiration as first strategy was performed in 50.7% of the patients in the Mothership paradigm group, versus 50.2% in the Drip-and-Ship. Onset to groin puncture time was 170 minutes (IQR, 142 to 207) in the Mothership group versus 262 minutes (IQR, 216 to 295) in the Drip-and-Ship group (p<0.001). Primary efficacy outcome was not significantly different in Mothership and Drip-and-Ship groups (50.4% versus 46.2%); the risk ratio (Mothership vs. Drip-and-Ship) was 1.06 (p=0.60, 95% CI: 0.84 to 1.33). Of the angiographic efficacy outcomes (Revascularization after first line strategy and at end of all procedures), adverse events, no significant differences were found between the two paradigms. Conclusions: The Mothership treatment paradigm did not result in better functional neurological outcome at 3 months compared to the Drip-and-Ship paradigm, whatever the first line treatment strategy.