Effect of the phenotype of the M1-middle cerebral artery occlusion on the recanalization rates in the ASTER trial. (28th June 2019)

• Record Type: Journal Article
• Authors: Consoli, Arturo; Zhu, François; Bourcier, Romain; Dargazanli, Cyril; Marnat, Gaultier; Duhamel, Alain; Blanc, Raphaël; Saleme, Suzana; Costalat, V; Desal, Hubert; Bracard, Serge; Labreuche, Julien; Kyheng, Maeva; Puccinelli, Francesco; Mosimann, Pascal J; Gory, Benjamin; Piotin, Michel; Lapergue, Bertrand
• Other Names: author non-byline.; Piotin Michel author non-byline.; Blanc Raphael author non-byline.; Redjem Hocine author non-byline.; Ciccio Gabriele author non-byline.; Smajda Stanislas author non-byline.; Mazighi Mikael author non-byline.; Fahed Robert author non-byline.; Desilles Jean Philippe author non-byline.; Maacha Malek Ben author non-byline.; Lapergue Bertrand author non-byline.; Rodesch Georges author non-byline.; Consoli Arturo author non-byline.; Coskun Oguzhan author non-byline.; Maria Federico Di author non-byline.; Bourdain Frédéric author non-byline.; Decroix Jean Pierre author non-byline.; Wang Adrien author non-byline.; Tchkviladze Maya author non-byline.; Evrard Serge author non-byline.; Lopez Delphine author non-byline.; Turjman Francis author non-byline.; Gory Benjamin author non-byline.; Labeyrie Paul Emile author non-byline.; Riva Roberto author non-byline.; Mounayer Charbel author non-byline.; Saleme Suzanna author non-byline.; Costalat Vincent author non-byline.; Bonafé Alain author non-byline.; Eker Omer author non-byline.; Gascou Grégory author non-byline.; Dargazanli Cyril author non-byline.; Bracard Serge author non-byline.; Tonnelet Romain author non-byline.; Derelle Anne Laure author non-byline.; Anxionnat René author non-byline.; Desal Hubert author non-byline.; Bourcier Romain author non-byline.; Daumas-duport B author non-byline.; Berge Jérome author non-byline.; Barreau Xavier author non-byline.; Marnat Gaultier author non-byline.; Djemmane Lynda author non-byline.; Labreuche Julien author non-byline.; Duhamel Alain author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 12:Number 1(2020)
• Page Start: 7
• Page End: 12
• Publication Date: 2019-06-28
• Subjects: stroke -- thrombectomy -- stent -- angiography; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2019-015002
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: An adequate recanalization grade is an independent predictor of a good clinical outcome in patients with acute ischemic stroke. It can be obtained with stent retrievers (SR) and contact aspiration (CA). The aim of this ancillary study of the ASTER trial was to investigate the effect of the regular and irregular phenotype of the M1-middle cerebral artery (M1-MCA) segment occlusion on the procedural and clinical outcomes in the ASTER trial population. Methods: The predetermined occlusion phenotype assessment was performed by the core laboratory of the ASTER trial and patients with M1-MCA occlusion were included in this study. Clinical and procedural outcomes were analyzed according to the technique used and to the occlusion phenotype. Results: 188 patients were included in the analysis (95 received SR, 93 CA as first-line treatment). The occlusion phenotypes were graded as irregular in 52.7% of cases (n=99, 95% CI 45.5% to 59.8%). In patients with an irregular occlusion phenotype, complete or adequate recanalization at the end of the first-line strategy was more often achieved with SR than CA (TICI 3: SR 44.1% vs CA 22.5%, OR 0.35, 95% CI 0.14 to 0.89, p=0.027), with a shorter procedure time, a lower number of passes (>2 passes: SR 32.2% vs CA 57.5%, OR 3.31, 95% CI 1.36 to 8.03, p=0.009), and higher rates of favorable clinical outcome (SR 55.2% vs CA 31.6%, OR 0.40, 95% CI 0.16 to 0.97, p=0.042). Conclusion: Irregular M1-MCA occlusion phenotypes treated with SR as first-line approach were associated with better procedural and clinical outcomes in the ASTER trial population