First-Line Thrombectomy for Acute Intracranial Atherosclerotic Stenosis-Related Vertebrobasilar Artery Occlusion: Stent Retriever-Based Versus Contact Aspiration Thrombectomy Strategies.

PURPOSE: To compare procedural and clinical outcomes of first-line contact aspiration thrombectomy (CAT) versus a stent retriever-based strategy in acute intracranial atherosclerotic stenosis (ICAS)-related vertebrobasilar artery occlusion (VBAO).

MATERIALS AND

METHODS

This retrospective two-center study included consecutive patients with acute ICAS-related VBAO treated between 2019 and 2024. Patients were classified by first-line strategy as CAT or an SRT-based strategy comprising stent retriever thrombectomy alone or with aspiration assistance. Primary outcomes were first-pass recanalization (FPR; modified Thrombolysis in Cerebral Infarction grade ≥ 2b after one device pass) and 90-day favorable functional outcome (modified Rankin Scale score 0-3). Multivariable regression was used for outcome comparisons, with inverse probability weighting (IPW) as a sensitivity analysis.

RESULTS

Among 129 patients, 38 received CAT and 91 received an SRT-based strategy. FPR was higher with the SRT-based strategy than with CAT (74.7% vs. 52.6%; adjusted odds ratio [aOR], 2.66; 95% CI, 1.15-6.16; p = 0.022). The 90-day favorable outcome did not differ significantly (48.4% vs. 36.8%; aOR, 1.69; 95% CI, 0.71-4.02; p = 0.235). In the primary adjusted analysis, the SRT-based strategy was associated with lower 90-day mortality (19.8% vs. 34.2%; aOR, 0.37; 95% CI, 0.15-0.96; p = 0.041), fewer strategy switches (1.1% vs. 34.2%; p < 0.001), and shorter puncture-to-recanalization time (63.0 vs. 73.5 min; p = 0.003). IPW supported these procedural advantages, whereas clinical outcome differences were nonsignificant.

CONCLUSION

In acute ICAS-related VBAO, a first-line SRT-based strategy was associated with better procedural performance than CAT, including higher first-pass recanalization, fewer strategy switches, and shorter puncture-to-recanalization time.