Frontline aspiration versus stent retriever thrombectomy for M2 occlusions: Insights from the STAR registry.
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Gaub Michael, Abo Kasem Rahim, Maier Ilko, Rai Ansaar, Jabbour Pascal, Kim Joon-Tae, Howard Brian, Alawieh Ali, Wolfe Stacey Quintero, Starke Robert M, Psychogios Marios-Nikos, Shaban Amir, Goyal Nitin, Dye Justin, Alaraj Ali, Ezzeldin Mohamad, Yoshimura Shinichi, Fiorella David, Tanweer Omar, Romano Daniele G, Navia Pedro, Cuellar Hugo, Fragata Isabel, Polifka Adam, Osbun Joshua, Siddiqui Fazeel, Moss Mark, Limaye Kaustubh, Mokin Maxim, Matouk Charles, Park Min S, Brinjikji Waleed, Daglioglu Ergun, Williamson Richard, Altschul David J, Ogilvy Christopher S, Crosa Roberto, Levitt Michael R, Gory Benjamin, Paul Alexandra, Kan Peter, Casagrande Walter, Chowdhry Shakeel, Stiefel Michael F, Grandhi Ramesh, Spiotta Alejandro, Mascitelli Justin
Аннотация
METHODS: Retrospective analysis of a multicenter stroke thrombectomy cohort identified cases of MT for M2 occlusions. Unmatched and propensity score-matched (PSM) cohorts were generated comparing frontline aspiration to standalone and combined SR. The primary outcome was functional independence (mRS 0-2) at 90 days. Recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and the effect of M2 laterality, division occlusion and procedure time were assessed.
RESULTS: About 1734 patients with M2 occlusions underwent either frontline aspiration (n = 711) or SR/combined (n = 958) thrombectomy between 2013 and 2024. PSM analysis favored aspiration for functional independence (49.9% vs 44.0%, OR 1.27 (1.03-1.57)), complete recanalization (61.2% vs 48.7%, OR 1.66 (1.34-2.05)), complete first pass effect (35.0% vs 27.6%, OR 1.42 (1.13-1.78)), and sICH (3.5% vs 6.2%, OR 0.55 (0.33-0.91)), with no difference in mortality. Frontline aspiration had significantly shorter procedural times (median 28 [IQR 15-49.5] vs 51 [IQR 35-78] minutes; p < 0.001). For every minute increase in procedure time, the probability of functional independence decreased significantly (p < 0.001) less with frontline aspiration (0.35%) compared to SR/combined (1.61%).
CONCLUSION: Frontline aspiration for M2 occlusions resulted in better clinical and angiographic outcomes compared to SRs. Future trials for MeVO with a focus on contact aspiration thrombectomy may succeed where recent trials have failed.