Contact Aspiration Versus Combined Thrombectomy in Basilar Artery Occlusion: Clinical Severity and First-pass Recanalization Are Associated with Outcome.
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Vega-Villar Juan, Barrios-Lopez Andrés Javier, Rojas-Jimenez Ana María, Bermejo-Garcés Rebeca, Domínguez-Rodríguez Carlos, Fernández-López Ángela, de la Rosa Carmen, Ortega-Quintanilla Joaquin, Seoane-Dopico Marta, Trejo Carmen, Rodríguez-Benítez Amado, Balboa Oscar, Ormeño Cristian, Díaz-Pérez José, Taboada Jose Luis, Parra-Ramírez Paula Andrea, Hidalgo-Barranco Carlos, Gassio-Riu Marc, Murias Eduardo, Mendez-Cendón Jose Carlos, Martínez-Galdamez Mario, Alonso-Lacabe Maitane, Aparici-Robles Fernando, Comas-Cufí Marc, Puig Josep, Zamarro Joaquín, Navia Pedro
Аннотация
METHODS: In the prospective multicenter SARA-3 registry, the primary outcomes compared between CA and CA + SR were first-pass recanalization (modified Treatment in Cerebral Infarction [mTICI] 2b-3) and 3‑month functional independence. Secondary outcomes were final recanalization, procedural time, safety, 24‑h NIHSS, and mortality. Factors associated with unfavorable outcome (modified Rankin Scale [mRS] 3-6) were assessed by Firth penalized logistic regression, with first-line technique forced in as a sensitivity analysis.
RESULTS: Among 68 patients (median admission National Institutes of Health Stroke Scale [NIHSS] 11), 50 (73.5%) received CA and 18 (26.5%) CA + SR. The two techniques showed no statistically significant differences in reperfusion, safety, or 3‑month unfavorable outcome (48% vs. 53%; underpowered), but CA was faster (21 vs. 38 min; P = 0.007). Admission NIHSS (odds ratio [OR] 1.08 per point; P = 0.004) and first-pass mTICI 2b-3 (OR 0.06; P < 0.001) were independently associated with outcome; their combination discriminated well (area under the curve 0.83). Forcing technique into the model did not change these associations (CA + SR adjusted OR 1.19; P = 0.81). No baseline characteristic was independently associated with first-pass reperfusion.
CONCLUSIONS: CA and CA + SR showed no statistically significant difference in 3‑month outcomes, but CA was faster. First-line technique was not associated with functional outcome; instead, outcome reflected baseline stroke severity and first-pass reperfusion, which defined prognostic groups that may aid risk stratification if externally validated.