Lapergue B, et al. - An analysis was performed to compare the efficacy and adverse events using the contact aspiration technique vs the standard stent retriever technique as a first-line endovascular treatment for successful revascularization among patients with acute ischemic stroke and large vessel occlusion. The first-line thrombectomy with contact aspiration compared with stent retriever did not result in an increased revascularization rate at the end of the procedure among patients with ischemic stroke in the anterior circulation undergoing thrombectomy.

Methods

• The Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) study was a randomized, open-label, blinded end-point clinical trial.
• This trial was conducted in 8 comprehensive stroke centers in France (October 2015-October 2016).
• The researchers included patients who presented with acute ischemic stroke and a large vessel occlusion in the anterior circulation within 6 hours of symptom onset.
• They randomly assigned patients to first-line contact aspiration (n = 192) or first-line stent retriever (n = 189) immediately prior to mechanical thrombectomy.
• The proportion of patients with successful revascularization defined as a modified Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all endovascular procedures was the primary outcome.
• The degree of disability evaluated by overall distribution of the modified Rankin Scale (mRS) score at 90 days, change in National Institutes of Health Stroke Scale (NIHSS) score at 24 hours, all-cause mortality at 90 days and procedure-related serious adverse events were included as secondary outcomes.

Results

• The trial was completed by 363 (95.3%), among 381 patients randomized (mean age, 69.9 years; 174 women [45.7%]).
• From symptom onset to arterial puncture, the median time was 227 minutes (interquartile range, 180-280 minutes).
• The proportion of patients with successful revascularization was 85.4% (n = 164) in the contact aspiration group vs 83.1% (n = 157) in the stent retriever group (odds ratio, 1.20 [95% CI, 0.68-2.10]; P=.53; difference, 2.4% [95% CI, -5.4% to 9.7%]), for the primary outcome.
• No significant differences were observed between groups for the clinical efficacy outcomes (change in NIHSS score at 24 hours, mRS score at 90 days) and adverse events.