Article Text

Original research
Aspiration only versus stent retriever only thrombectomy in basilar artery occlusion: a propensity score-matched analysis of the German Stroke Registry
  1. Johannes Wischmann1,
  2. Hanna Zimmermann2,
  3. Linus Keidel1,
  4. Thomas Liebig2,
  5. Christian H Nolte3,4,5,6,
  6. Lars Kellert1
  7. for the GSR-ET investigators
      1. 1Department of Neurology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
      2. 2Institute for Neuroradiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
      3. 3Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
      4. 4Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
      5. 5Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
      6. 6German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
      1. Correspondence to Dr Lars Kellert, Department of Neurology, Ludwig-Maximilians-University (LMU) Munich, Munich, 81377, Germany; Lars.Kellert{at}med.uni-muenchen.de

      Abstract

      Background Endovascular treatment has become the standard care for acute basilar artery occlusion (BAO). Uncertainty persists about the optimal thrombectomy technique.

      Objective To compare aspiration thrombectomy with stent retriever thrombectomy in patients with BAO in a multicenter real-world patient population.

      Methods We analyzed data from the German Stroke Registry-Endovascular Treatment (GSR-ET). Patients with isolated BAO who underwent either aspiration or stent retriever thrombectomy were compared, including propensity score matching (PSM). The primary outcome measure was the modified Rankin Scale shift analysis at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), procedure complications, and metrics.

      Results Of 13 082 patients in the GSR-ET, 387 patients (mean age 72.0±13.1 years; 45.0% female) fulfilled the inclusion criteria. The thrombectomy technique was aspiration only in 195 (50.4%) and stent retriever only in 192 (49.6%) patients. Functional outcome did not differ between the groups, either before (common OR (cOR) 0.94; 95% CI 0.64 to 1.38) or after PSM (cOR=1.37; 95% CI 0.90 to 2.09). There was no significant difference in sICH (2.6 vs 5.5%; P=0.231; OR=0.46; 95% CI 0.14 to 1.47), but aspiration thrombectomy demonstrated fewer procedure-related complications (4.6% vs 12.5%; P=0.017), a shorter procedure duration (24 vs 48 min; P<0.001), and higher first pass recanalization rates (75.1% vs 44.8%; P<0.001).

      Conclusions In this study both aspiration and stent retriever thrombectomy showed equal efficacy in terms of functional outcome in patients with BAO. However, procedure complications and metrics might favor aspiration over stent retriever thrombectomy.

      • Stroke
      • Thrombectomy
      • Technique

      Data availability statement

      Data are available upon reasonable request. The data that support the results of this study are available from the corresponding author upon reasonable request.

      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/.

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      Data availability statement

      Data are available upon reasonable request. The data that support the results of this study are available from the corresponding author upon reasonable request.

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      Footnotes

      • Collaborators GSR-ET investigators:Tobias BoeckhBehrens, Silke Wunderlich, Alexander Ludolph, Karl-Heinz Henn, Arno Reich, Omid Nikoubashm an, Ulrike Ernemann, Sven Poli, Christian H Nolte, Eberhard Siebert, Sarah Zweynert, Georg Bohner, Gabor Petzold, Fee Keil, Joachim Röther, Bernd Eckert, Jörg Berrouschot, Albrecht Bormann, Anna Alegiani, Jens Fiehler, Christian Gerloff, Götz Thomalla, Christoffer Kraemer, Jan Liman, Martina Petersen, Florian Stögbauer, Michael Braun, Gerhard F. Hamann, Klaus Gröschel, Timo Uphaus, Jan Borggrefe, Franziska Dorn, Marielle Ernst, Jörg Hattingen, Hannes Leischner, Jan Hendrik Schäfer, Maximilian Schell, Peter Schellinger, Christoph Trumm.

      • Contributors JW and LKel conceptualized the study. JW, HZ, and LKel collected the data. JW carried out the analysis and wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript. LKel acts as the guarantor of this study.

      • 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 LKel has received funding for travel or speaker honoraria from Alexion, AstraZeneca, Bayer Vital, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, and Pfizer outside of this study. CHN has received funding for travel or speaker honoraria from Alexion, Astra-Zeneca, Bayer Vital, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer, and Takeda.

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

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