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Ischemic Stroke
Original research
Effect of the phenotype of the M1-middle cerebral artery occlusion on the recanalization rates in the ASTER trial
  1. Arturo Consoli1,
  2. François Zhu2,
  3. Romain Bourcier3,
  4. Cyril Dargazanli4,
  5. Gaultier Marnat5,
  6. Alain Duhamel6,
  7. Raphaël Blanc7,
  8. Suzana Saleme8,
  9. V Costalat9,
  10. Hubert Desal10,
  11. Serge Bracard11,
  12. Julien Labreuche12,
  13. Maeva Kyheng13,
  14. Francesco Puccinelli14,
  15. Pascal J Mosimann15,16,
  16. Benjamin Gory,
  17. Michel Piotin7,
  18. Bertrand Lapergue17
  19. on behalf of the ASTER Trial Investigators
    1. 1 Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
    2. 2 Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
    3. 3 Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
    4. 4 Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France
    5. 5 Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
    6. 6 Biostatistics, University of Lille, Lille, France
    7. 7 Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
    8. 8 Interventional Neuroradiology, CHU Limoges, Limoges, France
    9. 9 CHU Montpellier, Montpellier, France
    10. 10 Neuroradiology, University Hospital of Nantes, Nantes, France
    11. 11 Centre Hospitalier Universitaire de Nancy, Nancy, France
    12. 12 Université Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, Lille, France
    13. 13 Université Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Université de Lille, Lille, France
    14. 14 Department of Radiology, Interventional Neuroradiology Unit, University Hospital of Lausanne, Lausanne, Switzerland
    15. 15 Department of Interventional and Diagnostic Neuroradiology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
    16. 16 Department of Diagnostic and Interventional Neuroradiology, Inselspital - Bern University Hospital, Bern, Switzerland
    17. 17 Department of Stroke and Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France
    1. Correspondence to Dr Arturo Consoli, Diagnostic and Interventional Neuroradiology, Hospital Foch, 92150 Suresnes, France; onemed21{at}gmail.com

    Abstract

    Introduction An adequate recanalization grade is an independent predictor of a good clinical outcome in patients with acute ischemic stroke. It can be obtained with stent retrievers (SR) and contact aspiration (CA). The aim of this ancillary study of the ASTER trial was to investigate the effect of the regular and irregular phenotype of the M1-middle cerebral artery (M1-MCA) segment occlusion on the procedural and clinical outcomes in the ASTER trial population.

    Methods The predetermined occlusion phenotype assessment was performed by the core laboratory of the ASTER trial and patients with M1-MCA occlusion were included in this study. Clinical and procedural outcomes were analyzed according to the technique used and to the occlusion phenotype.

    Results 188 patients were included in the analysis (95 received SR, 93 CA as first-line treatment). The occlusion phenotypes were graded as irregular in 52.7% of cases (n=99, 95% CI 45.5% to 59.8%). In patients with an irregular occlusion phenotype, complete or adequate recanalization at the end of the first-line strategy was more often achieved with SR than CA (TICI 3: SR 44.1% vs CA 22.5%, OR 0.35, 95% CI 0.14 to 0.89, p=0.027), with a shorter procedure time, a lower number of passes (>2 passes: SR 32.2% vs CA 57.5%, OR 3.31, 95% CI 1.36 to 8.03, p=0.009), and higher rates of favorable clinical outcome (SR 55.2% vs CA 31.6%, OR 0.40, 95% CI 0.16 to 0.97, p=0.042).

    Conclusion Irregular M1-MCA occlusion phenotypes treated with SR as first-line approach were associated with better procedural and clinical outcomes in the ASTER trial population

    • stroke
    • thrombectomy
    • stent
    • angiography

    https://doi.org/10.1136/neurintsurg-2019-015002

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      Footnotes

      • Contributors All the authors participated with substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. All the authors participated in drafting the work or revising it critically for important intellectual content. They gave the final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement All the data are presented in the manuscript and in the supplemental material and are available upon reasonable request to the corresponding author.

      • Collaborators Michel Piotin, Raphael Blanc, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Robert Fahed, Jean Philippe Desilles, Malek ben Maacha, Bertrand Lapergue, Georges Rodesch, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchkviladze, Serge Evrard, Delphine Lopez, Francis Turjman, Benjamin Gory, Paul Emile Labeyrie, Roberto Riva, Charbel Mounayer, Suzanna Saleme, Vincent Costalat, Alain Bonafé, Omer Eker, Grégory Gascou, Cyril Dargazanli, Serge Bracard, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Hubert Desal, Romain Bourcier, B Daumas-Duport, Jérome Berge, Xavier Barreau, Gaultier Marnat, Lynda Djemmane, Julien Labreuche, Alain Duhamel

      • Patient consent for publication Not required.