PT  - JOURNAL ARTICLE
AU  - Célina Ducroux
AU  - Michel Piotin
AU  - Benjamin Gory
AU  - Julien Labreuche
AU  - Raphael Blanc
AU  - Malek Ben Maacha
AU  - Bertrand Lapergue
AU  - Robert Fahed
ED  - ,
TI  - First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial
AID  - 10.1136/neurintsurg-2019-015215
DP  - 2020 Apr 01
TA  - Journal of NeuroInterventional Surgery
PG  - 386--391
VI  - 12
IP  - 4
4099  - http://jnis.bmj.com/content/12/4/386.short
4100  - http://jnis.bmj.com/content/12/4/386.full
SO  - J NeuroIntervent Surg2020 Apr 01; 12
AB  - 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.