Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.
- Author:
Romain BOURCIER
1
;
Mickael MAZIGHI
;
Julien LABREUCHE
;
Robert FAHED
;
Raphael BLANC
;
Benjamin GORY
;
Alain DUHAMEL
;
Gaultier MARNAT
;
Suzana SALEME
;
Vincent COSTALAT
;
Serge BRACARD
;
Hubert DESAL
;
Arturo CONSOLI
;
Michel PIOTIN
;
Bertrand LAPERGUE
Author Information
- Publication Type:Original Article
- Keywords: Thrombectomy; Thrombosis; Retrieval device; Aspiration catheter
- MeSH: Arm; Cerebral Infarction; Humans; Magnetic Resonance Imaging; Odds Ratio; Population Characteristics; Random Allocation; Stents*; Thrombectomy; Thrombosis
- From:Journal of Stroke 2018;20(2):268-276
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND PURPOSE: In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) was studied to determine its influence on trial results. METHODS: We included patients having undergone CA or SR for M1 or M2 occlusions, who were screened by MRI with T2* gradient recalled echo. Occlusions were classified as SVS (+) or SVS (–) in each randomization arm. Modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3 revascularization rates were recorded and clinical outcomes assessed by the overall distribution of modified Rankin scale (mRS) at 90 days. RESULTS: Among the 202 patients included, 143 patients were SVS (+) (70.8%; 95% confidence interval [CI], 64.5% to 77.1%). Overall, there was no difference in angiographic and clinical outcomes according to SVS status. However, compared to SR, CA achieved a lower mTICI 2c/3 rate in SVS (+) patients (risk ratio [RR] for CA vs. SR, 0.60; 95% CI, 0.51 to 0.71) but not in SVS (–) (RR, 1.11; 95% CI, 0.69 to 1.77; P for interaction=0.018). A significant heterogeneity in favor of superiority of first-line SR strategy in SVS (+) patients was also found regarding the overall mRS distribution (common odds ratio for CA vs. SR, 0.40 vs. 1.32; 95% CI, 0.21 to 0.74 in SVS (+) vs. 95% CI, 0.51 to 3.35 in SVS (–); P for interaction=0.038). CONCLUSIONS: As a first line strategy, SR achieved higher recanalization rates and a more favourable clinical outcome at 3 months compared to CA when MRI shows SVS within the thrombus.
