Background Mechanical thrombectomy with stent retrievers has proved to be safe and effective in endovascular treatment of acute ischemic stroke. Direct aspiration has shown revascularization rates comparable to those of stent retrievers in the recent ASTER and COMPASS trials. However, the efficacy of aspiration in routine clinical practice has not yet been shown.
Objective To show that aspiration has clinical and technical outcomes equal to those of stent retriever thrombectomy in daily clinical practice.
Methods We analysed data of patients with a large vessel occlusion of the anterior circulation registered in the Dutch MR CLEAN Registry between March 2014 and June 2016. Primary outcome was functional outcome measured with the modified Rankin Scale (mRS) score. Secondary outcomes were reperfusion grade, periprocedural complication rate, and procedure duration. Association of treatment technique with functional outcome was estimated with univariable and multivariable ordinal logistic regression analysis and expressed as a common OR (cOR) for a shift towards better outcome on the mRS.
Results As first-line treatment, 207 of 1175 patients (17.6%) were treated with direct aspiration, and 968 (82.4%) by a stent retriever. We observed no differences in functional outcome (adjusted cOR=1.020 (95% CI 0.68 to 1.52)) and periprocedural complications. Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2b) was similar. Duration of the procedure was shorter with aspiration (57 min (IQR 35–73) vs 70 min (IQR 47–95), p<0.0001).
Conclusion Direct aspiration shows clinical outcomes equal to those of stent retriever thrombectomy in our large multicenter real-life cohort. We found no difference in complication rates and shorter procedure times for aspiration.
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Contributors MLEB wrote the statistical analysis plan, designed the first draft, conducted the statistical analysis, and revised the draft paper. R-JBG, JMM, and JH participated in study design, data collection, data analysis, interpretation, and writing of the manuscript. R-JBG, JH, JMM, WHvZ, RJvO, YBWEMR, and MU revised the draft paper. The study coordinators, local investigators, and members of the executive, imaging, and complication committees collected the data. All authors critically reviewed the manuscript and approved the final version.
Funding The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Centre, Maastricht University Medical Centre and Academic Medical Centre Amsterdam.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The Erasmus University MC, Rotterdam, The Netherlands (MEC-2014-235).
Provenance and peer review Not commissioned; externally peer reviewed.
Collaborators The collaborator details can be found in the online supplementary file.
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