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Ischemic Stroke
Original research
First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial
  1. Célina Ducroux1,
  2. Michel Piotin1,
  3. Benjamin Gory2,
  4. Julien Labreuche3,
  5. Raphael Blanc1,
  6. Malek Ben Maacha1,
  7. Bertrand Lapergue4,
  8. Robert Fahed1
  9. for the ASTER Trial investigators
    1. 1 Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
    2. 2 Department of Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
    3. 3 Department of Biostatistics, EA 2694-Santé Publique,Epidémiologie et Qualité des Soins, CHU Lille, Lille, France
    4. 4 Department of Stroke Center, Foch Hospital, Suresnes, France
    1. Correspondence to Dr Robert Fahed, Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris 75019, France; robert.fahed{at}hotmail.fr

    Abstract

    Background The ‘first pass effect’ (FPE), which was originally described with stent retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality.

    Objective We report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial.

    Materials and methods ASTER is a randomized trial comparing angiographic revascularization with the stent retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients.

    Results FPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients.

    Conclusion In the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted.

    Trial registration number Unique identifier: NCT02523261.

    • stroke
    • thrombectomy
    • recanalization
    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/neurintsurg-2019-015215

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      Footnotes

      • Contributors Study design: CD, MP, JL, BL, RF. Acquisition, analysis, or interpretation of data: all authors.Drafting of the manuscript: CD, MP, JL, BL, RF. Statistical analysis: JL. Supervision: RF.

      • 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 Data, analytic methods, and study materials will be made available to any researcher for purposes of reproducing the results or replicating the procedure. Requests to receive these materials should be sent to the corresponding author, who will maintain their availability.

      • Collaborators ASTER trial investigators: Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Mikael Mazighi, Jean-Philippe Desilles, Simon Escalard, Georges Rodesch, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Frédéric Bourdain, Jean Pierre Decroix, Adrien Wang, Maya Tchikviladze, Serge Evrard, Francis Turjman, Benjamin Gory, Paul Emile Labeyrie, Roberto Riva, Charbel Mounayer, Suzanna Saleme, Vincent Costalat, Alain Bonafe, Omer Eker, Grégory Gascou, Cyril Dargazanli, Serge Bracard, Romain Tonnelet, Anne Laure Derelle, René Anxionnat, Hubert Desal, Romain Bourcier, Benjamin Daumas-Duport, Jérome Berge, Xavier Barreau, Gauthier Marnat, Lynda Djemmane, Julien Labreuche, Alain Duhamel

      • Patient consent for publication Not required.