A first-line contact aspiration technique demonstrates no significant benefit over the stent retriever technique in achieving revascularization in patients with acute ischemic stroke and large vessel occlusion, according to recent findings from a randomized clinical trial published in JAMA.
Investigators of the Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) trial designed a randomized, blinded, open-label trial to assess efficacy and adverse events associated with the use of first-line thrombectomy with either the contact aspiration technique (n=192) or the standard stent retriever technique (n=189). Patient data were obtained from 8 stroke centers in France and included participants with acute ischemic stroke and large vessel occlusion.
A total of 363 patients (95.3%) completed the trial and were included in the final analysis. Successful revascularization was achieved in 164 (85.4%) and 157 (83.1%) patients in the contact aspiration and stent retriever groups, respectively (odds ratio [OR], 1.20; 95% CI, 0.68-2.10; P =.53). No significant differences were observed in revascularization rates or attempts.
At 24 hours, there was an average change in National Institutes of Health Stroke Scale score of −5.2 points in the stent retriever group and −4.8 points in the contact aspiration group (P =.68). No significant differences were observed between the 2 groups in regard to 3-month all-cause mortality, intracranial hemorrhage at 24 hours, or procedure-related adverse events.
According to the investigators, the use of rescue therapy depended on operator’s preference, which might have contributed to potential bias. In addition, centers participating in this study were experienced performers of both endovascular techniques, thereby limiting the applicability of the study’s findings to low-volume stroke centers that may have less experience.
The investigators pointed out that although the findings demonstrated no superiority of the contact aspiration technique over the stent retriever technique for achieving successful revascularization, the trial “was not designed to claim equivalence or noninferiority of these strategies.”
Lapergue B, Blanc R, Gory B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA. 2017;318(5):443-452.