First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry. (10th May 2021)

• Record Type: Journal Article
• Authors: Maïer, Benjamin; Finitsis, Stephanos; Bourcier, Romain; Papanagiotou, Panagiotis; Richard, Sébastien; Marnat, Gaultier; Sibon, Igor; Dargazanli, Cyril; Arquizan, Caroline; Blanc, Raphael; Piotin, Michel; Lapergue, Bertrand; Consoli, Arturo; Eugene, Francois; Vannier, Stephane; Saleme, Suzana; Macian, Francisco; Clarençon, Frédéric; Rosso, Charlotte; Naggara, Olivier; Turc, Guillaume; Viguier, Alain; Cognard, Christophe; Wolff, Valerie; Pop, Raoul; Mazighi, Mikael; Gory, Benjamin
• Other Names: author non-byline.; Redjem Hocine author non-byline.; Escalard Simon author non-byline.; Desilles Jean-Philippe author non-byline.; Redjem Hocine author non-byline.; Ciccio Gabriele author non-byline.; Smajda Stanislas author non-byline.; Fahed Robert author non-byline.; Obadia Mikael author non-byline.; Sabben Candice author non-byline.; Corabianu Ovide author non-byline.; Broucker Thomas de author non-byline.; Smadja Didier author non-byline.; Alamowitch Sonia author non-byline.; Ille Olivier author non-byline.; Manchon Eric author non-byline.; Garcia Pierre-Yves author non-byline.; Taylor Guillaume author non-byline.; Maacha Malek Ben author non-byline.; Bourdain Frédéric author non-byline.; Jean-pierre Decroix author non-byline.; Wang Adrien author non-byline.; Evrard Serge author non-byline.; tchikviladze Maya author non-byline.; Coskun Oguzhan author non-byline.; Maria Federico Di author non-byline.; Rodesh Georges author non-byline.; Leguen Morgan author non-byline.; Tisserand Marie author non-byline.; Pico Fernando author non-byline.; Rakotoharinandrasana Haja author non-byline.; Tassan Philippe author non-byline.; Poll Roxanna author non-byline.; Gariel Florent author non-byline.; Barreau Xavier author non-byline.; Berge Jérôme author non-byline.; Menegon Patrice author non-byline.; Lucas Ludovic author non-byline.; Olindo Stéphane author non-byline.; Renou Pauline author non-byline.; Sagnier Sharmila author non-byline.; Poli Mathilde author non-byline.; Debruxelles Sabrina author non-byline.; Rouanet François author non-byline.; Tourdias Thomas author non-byline.; Liegey Jean-Sebastien author non-byline.; Briau Pierre author non-byline.; Pangon Nicolas author non-byline.; Detraz Lili author non-byline.; Daumas-Duport Benjamin author non-byline.; Alexandre Pierre-Louis author non-byline.; Roy Monica author non-byline.; Lenoble Cédric author non-byline.; Desal Hubert author non-byline.; Guillon Benoît author non-byline.; Gaalon Solène de author non-byline.; Preterre Cécile author non-byline.; Costa Isabelle author non-byline.; Bracard Serge author non-byline.; Anxionnat René author non-byline.; Braun Marc author non-byline.; Derelle Anne-Laure author non-byline.; Tonnelet Romain author non-byline.; Liao Liang author non-byline.; Zhu François author non-byline.; Schmitt Emmanuelle author non-byline.; Planel Sophie author non-byline.; Humbertjean Lisa author non-byline.; Mione Gioia author non-byline.; Lacour Jean-Christophe author non-byline.; Riou-Comte Nolwenn author non-byline.; Hossu Gabriela author non-byline.; Beaumont Marine author non-byline.; Bailang Mitchelle author non-byline.; Audibert Gérard author non-byline.; Reitter Marie author non-byline.; Masson Agnès author non-byline.; Alb Lionel author non-byline.; Tabarna Adriana author non-byline.; Voicu Marcela author non-byline.; Podar Iona author non-byline.; Brezeanu Madalina author non-byline.; Costalat Vincent author non-byline.; Gascou Grégory author non-byline.; Lefèvre Pierre-Henri author non-byline.; Derraz Imad author non-byline.; Riquelme Carlos author non-byline.; Gaillard Nicolas author non-byline.; Mourand Isabelle author non-byline.; Corti Lucas author non-byline.; Ferre Jean-Christophe author non-byline.; Raoult Helene author non-byline.; Ronziere Thomas author non-byline.; Lassale Maria author non-byline.; Boustia Fakhreddine author non-byline.; Gauvrit Jean-Yves author non-byline.; Tracol Clément author non-byline.; Langnier-Lemercier Sophie author non-byline.; Lassalle Veronica author non-byline.; Malrain Cecile author non-byline.; Tracol Clement author non-byline.; Ronziere Thomas author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 14:Number 5(2022)
• Publication Date: 2021-05-10
• Subjects: stent -- stroke -- catheter -- device -- thrombectomy; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2021-017505
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: The best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA). Objective: To compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT. Methods: We analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0–2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes. Results: We included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA. Conclusions: Despite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.