Aspiration Versus Stent-Retriever as First-Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity-Score Matched Multicenter Analysis

James E. Siegler; Hamza Shaikh; Jane Khalife; Solomon Oak; Linda Zhang; Mohamad Abdalkader; Piers Klein; Thanh N. Nguyen; Tareq Kass-Hout; Rami Z. Morsi; Jeremy J. Heit; Robert W. Regenhardt; Jose Danilo Bengzon Diestro; Nicole M. Cancelliere; Sherief Ghozy; Ahmad Sweid; Kareem El Naamani; Abdelaziz Amllay; Lukas Meyer; Anne Dusart; Flavio Bellante; Geraud Forestier; Aymeric Rouchaud; Suzana Saleme; Charbel Mounayer; Jens Fiehler; Anna Luisa Kuehn; Ajit S. Puri; Christian Dyzmann; Peter T. Kan; Marco Colasurdo; Gaultier Marnat; Jerome Berge; Xavier Barreau; Igor Sibon; Simona Nedelcu; Nils Henninger; Thomas R. Marotta; Alvin S. Das; Christopher J. Stapleton; James D. Rabinov; Takahiro Ota; Shogo Dofuku; Leonard L. L. Yeo; Benjamin Y. Q. Tan; Juan Carlos Martinez-Gutierrez; Sergio Salazar-Marioni; Sunil A. Sheth; Leonardo Renieri; Carolina Capirossi; Ashkan Mowla; Stavropoula I. Tjoumakaris; Pascal Jabbour; Priyank Khandelwal; Arundhati Biswas; Frederic Clarencon; Mahmoud Elhorany; Kevin Premat; Iacopo Valente; Alessandro Pedicelli; Joo Pedro Filipe; Ricardo Varela; Miguel Quintero-Consuegra; Nestor R. Gonzalez; Markus A. Moehlenbruch; Jessica Jesser; Vincent Costalat; Adrien ter Schiphorst; Vivek Yedavalli; Pablo Harker; Lina M. Chervak; Yasmin Aziz; Maria Bres Bullrich; Luciano Sposato; Benjamin Gory; Constantin Hecker; Monika Killer-Oberpfalzer; Christoph J. Griessenauer; Ajith J. Thomas; Cheng-Yang Hsieh; David S. Liebeskind; Razvan Alexandru Radu; Andrea M. Alexandre; Illario Tancredi; Tobias D. Faizy; Robert Fahed; Charlotte Weyland; Aman B. Patel; Vitor Mendes Pereira; Boris Lubicz; Adrien Guenego; Adam A. Dmytriw; MAD MT Consortium

doi:10.1161/SVIN.123.000931

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Aspiration Versus Stent-Retriever as First-Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity-Score Matched Multicenter Analysis

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Aspiration Versus Stent-Retriever as First-Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity-Score Matched Multicenter Analysis

James E. Siegler, Hamza Shaikh, Jane Khalife, Solomon Oak, Linda Zhang, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Tareq Kass-Hout, Rami Z. Morsi, …

Stroke: vascular and interventional neurology, Vol.3(6), 000931

01/11/2023

DOI: https://doi.org/10.1161/SVIN.123.000931

Résumé

Cardiovascular System & Cardiology

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Peripheral Vascular Disease

Science & Technology

BACKGROUND: For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent-retriever for first-line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first-line technique in a large, multicenter registry. METHODS: Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first-line endovascular technique (stent-retriever versus aspiration). Multivariable logistic regression and propensity-score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b-3 ("successful recanalization"), as well as secondary outcomes (first-pass effect, expanded Thrombolysis in Cerebral Infarction 2c-3, intracerebral hemorrhage, and 90-day modified Rankin scale, 90-day mortality) between treatment groups. RESULTS: Of the 440 included patients (44.5% stent-retriever versus 55.5% aspiration), those treated with stent-retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P<0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P=0.02), and nonsignificantly fewer medium-distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P=0.10). Use of a stent-retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74-0.98]; P=0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72-1.09]; P=0.24), or in the propensity-score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75-1.18]; P=0.60). There was no significant association between technique and secondary outcomes in the propensity-score matched adjusted models. CONCLUSION: In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent-retriever thrombectomy.

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Titre: Aspiration Versus Stent-Retriever as First-Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity-Score Matched Multicenter Analysis
Créateurs - sans rôle: James E. Siegler - Cooper Univ Hosp, Cooper Neurol Inst, Camden, NJ USA
Hamza Shaikh - Cooper Univ Hosp, Cooper Neurol Inst, Camden, NJ USA
Jane Khalife - Cooper Univ Hosp, Cooper Neurol Inst, Camden, NJ USA
Solomon Oak - Rowan Univ, Cooper Med Sch, Camden, NJ USA
Linda Zhang - Rowan Univ, Cooper Med Sch, Camden, NJ USA
Mohamad Abdalkader - College Station Medical Center
Piers Klein - College Station Medical Center
Thanh N. Nguyen - Boston Med Ctr, Dept Radiol & Neurol, Boston, MA USA
Tareq Kass-Hout - Univ Chicago, Dept Neurol, Chicago, IL USA
Rami Z. Morsi - Univ Chicago, Dept Neurol, Chicago, IL USA
Jeremy J. Heit - College Station Medical Center
Robert W. Regenhardt - Harvard University
Jose Danilo Bengzon Diestro - Univ Toronto, St Michaels Hosp, Div Diagnost & Therapeut Neuroradiol, Dept Med Imaging, Toronto, ON, Canada
Nicole M. Cancelliere - University of Toronto
Sherief Ghozy - Mayo Clin, Dept Radiol, Rochester, MN USA
Ahmad Sweid - Boston Med Ctr, Dept Radiol & Neurol, Boston, MA USA
Kareem El Naamani - Thomas Jefferson University
Abdelaziz Amllay - Thomas Jefferson University
Lukas Meyer - Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany
Anne Dusart - Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium
Flavio Bellante - Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium
Geraud Forestier - Univ Limoges, Univ Hosp Limoges, XLIM,CNRS, Dept Neuroradiol,Dupuytren,UMR 7252, Limoges, France
Aymeric Rouchaud - XLIM
Suzana Saleme - XLIM
Charbel Mounayer - Univ Limoges, Univ Hosp Limoges, XLIM,CNRS, Dept Neuroradiol,Dupuytren,UMR 7252, Limoges, France
Jens Fiehler - Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany
Anna Luisa Kuehn - Univ Massachusetts, Div Neurointervent Radiol, Dept Radiol, Med Ctr, Worcester, MA USA
Ajit S. Puri - College Station Medical Center
Christian Dyzmann - Lubeck GmbH, Sana Kliniken, Dept Neuroradiol, Lubeck, Germany
Peter T. Kan - College Station Medical Center
Marco Colasurdo - College Station Medical Center
Gaultier Marnat - Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France
Jerome Berge - Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France
Xavier Barreau - Bordeaux Univ Hosp, Intervent Neuroradiol Dept, Bordeaux, France
Igor Sibon - Bordeaux Univ Hosp, Dept Neurol, Bordeaux, France
Simona Nedelcu - Univ Massachusetts, Dept Neurol, Chan Med Sch, Worcester, MA USA
Nils Henninger - Univ Massachusetts, Dept Neurol, Chan Med Sch, Worcester, MA USA
Thomas R. Marotta - University of Toronto
Alvin S. Das - Harvard Med Sch, Dept Neurol, Beth Israel Deaconess Med Ctr, Boston, MA USA
Christopher J. Stapleton - Harvard University
James D. Rabinov - Harvard University
Takahiro Ota - Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan
Shogo Dofuku - Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan
Leonard L. L. Yeo - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Benjamin Y. Q. Tan - Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Med, Singapore, Singapore
Juan Carlos Martinez-Gutierrez - UTHealth McGovern Med Sch, Dept Neurol, Houston, TX USA
Sergio Salazar-Marioni - UTHealth McGovern Med Sch, Dept Neurol, Houston, TX USA
Sunil A. Sheth - UTHealth McGovern Med Sch, Dept Neurol, Houston, TX USA
Leonardo Renieri - Osped Careggi Firenze, Interventist Neurovasc, Florence, Italy
Carolina Capirossi - Osped Careggi Firenze, Interventist Neurovasc, Florence, Italy
Ashkan Mowla - Univ Southern Calif USC, Keck Sch Med, Div Stroke & Endovasc Neurosurg, Dept Neurol Surg, Los Angeles, CA USA
Stavropoula I. Tjoumakaris - Thomas Jefferson University
Pascal Jabbour - Thomas Jefferson University
Priyank Khandelwal - NJMS, Dept Endovasc Neurosurg & Neuroradiol, Newark, NJ USA
Arundhati Biswas - New York Medical College
Frederic Clarencon - Sorbonne Univ, Pitie Salpetriere Hosp, Dept Neuroradiol, GRC BioFast, Paris, France
Mahmoud Elhorany - Sorbonne Univ, Pitie Salpetriere Hosp, Dept Neuroradiol, GRC BioFast, Paris, France
Kevin Premat - Sorbonne Univ, Pitie Salpetriere Hosp, Dept Neuroradiol, GRC BioFast, Paris, France
Iacopo Valente - Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Florence, Italy
Alessandro Pedicelli - Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Florence, Italy
Joo Pedro Filipe - Ctr Hosp Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal
Ricardo Varela - Ctr Hosp Univ Porto, Dept Neurol, Porto, Portugal
Miguel Quintero-Consuegra - College Station Medical Center
Nestor R. Gonzalez - College Station Medical Center
Markus A. Moehlenbruch - Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany
Jessica Jesser - Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany
Vincent Costalat - Montpellier Univ, Gui de Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France
Adrien ter Schiphorst - Montpellier Univ, Gui de Chauliac Hosp, Dept Neurol, Med Ctr, Montpellier, France
Vivek Yedavalli - College Station Medical Center
Pablo Harker - University of Cincinnati
Lina M. Chervak - University of Cincinnati
Yasmin Aziz - University of Cincinnati
Maria Bres Bullrich - LHSC Univ Hosp, Dept Med Imaging & Neurol, London, ON, Canada
Luciano Sposato - LHSC Univ Hosp, Dept Med Imaging & Neurol, London, ON, Canada
Benjamin Gory - Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France
Constantin Hecker - University of Salzburg
Monika Killer-Oberpfalzer - University of Salzburg
Christoph J. Griessenauer - University of Salzburg
Ajith J. Thomas - Cooper Univ Hosp, Cooper Neurol Inst, Camden, NJ USA
Cheng-Yang Hsieh - Sin Lau Hosp, Dept Neurol, Tainan, Taiwan
David S. Liebeskind - UCLA, Stroke Ctr, Los Angeles, CA USA
Razvan Alexandru Radu - Montpellier Univ, Gui de Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France
Andrea M. Alexandre - Fdn Policlin Univ A Gemelli IRCCS Roma, UOSA Neuroradiol Interventist, Florence, Italy
Illario Tancredi - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Tobias D. Faizy - Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany
Robert Fahed - Ottawa Hosp, Res Inst, Div Neurol, Dept Med, Ottawa, ON, Canada
Charlotte Weyland - Univ Klinikum Heidelberg, Sekt Vaskulare & Intervent Neuroradiol, Heidelberg, Germany
Aman B. Patel - Harvard University
Vitor Mendes Pereira - University of Toronto
Boris Lubicz - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Adrien Guenego - Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium
Adam A. Dmytriw - Harvard Univ, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA
MAD MT Consortium
Détails de publication: Stroke: vascular and interventional neurology, Vol.3(6), 000931
Éditeur: Wiley
Nombre de pages: 11
Identifiants: 99163084009311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article