• Benjamin Gory, Bertrand Lapergue, Raphael Blanc, Julien Labreuche, Malek Ben Machaa, Alain Duhamel, Gautier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Mikael Mazighi, Arturo Consoli, Michel Piotin, and ASTER Trial Investigators.
• From the Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, France (B.G., S.B.); IADI, INSERM U947, University of Lorraine, Vandœuvre-lès-Nancy, France (B.G., S.B.); Department of Stroke Center (B.L.) and Department of Neuroradiology (A.C.), Foch Hospital, Suresnes, France; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.B.M., M.P.); Department of Biostatistics, University Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, France (J.L., A.D.); Department of Neuroradiology, University Hospital of Bordeaux, France (G.M.); Department of Interventional Neuroradiology, University Hospital of Limoges, France (S.S.); Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France (V.C.); and Department of Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France (H.D.). b.gory@chru-nancy.fr.
• Stroke. 2018 Feb 1; 49 (2): 461-464.

Background And PurposeMiddle cerebral artery M2-segment occlusions represent an important subgroup of patients with acute stroke with large-vessel occlusion. The safety of mechanical thrombectomy, especially contact aspiration (CA), in such distal intracranial occlusions is still under debate. We compared reperfusion, adverse events, neurological recovery, and functional outcome of patients with isolated M2 occlusions according to the first-line strategy mechanical thrombectomy devices (CA versus stent retriever [SR]).MethodsThis is a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). The primary outcome was successful reperfusion at the end of all endovascular procedures, defined as modified Thrombolysis in Cerebral Infarction (mTICI) scores 2b/3. Secondary outcomes were mTICI 2c/3 and mTICI 3, 90-day functional outcome, assessed with the modified Rankin Scale score. Safety outcomes included 90-day mortality and any symptomatic intracerebral hemorrhage.ResultsSeventy-nine patients were included: 48 were allocated to the CA group and 31 to the SR group. There were no significant differences between CA and SR groups in reperfusion after all endovascular procedures regarding mTICI 2b/3 (89.6% versus 83.9%; P=0.36), mTICI 2c/3 (54.2% versus 54.8%; P=0.90), and mTICI 3 (35.4% versus 41.9%; P=0.36) rates. There were no significant differences between CA and SR groups in 90-day modified Rankin Scale ≤2 rate (54.4% versus 50.0%; P=0.84), 24-hour change in National Institutes of Health Stroke Scale (mean difference, -3.9; 95% confidence interval, -7.9 to 0.01), and Alberta Stroke Program Early Computed Tomography score (mean difference, 0.9; 95% confidence interval, -0.1 to 2.0) scores. Safety parameters were well balanced between the 2 groups except for a higher 90-day mortality rate in the CA group (19.6% versus 3.3%; P=0.078).ConclusionsFirst-line mechanical thrombectomy with CA compared with SR did not result in an increased successful revascularization rate in patients with acute stroke with isolated M2 occlusion.© 2017 American Heart Association, Inc.

25 keywords...

hide…