Aspiration only versus stent retriever only thrombectomy in basilar artery occlusion: a propensity score-matched analysis of the German Stroke Registry.
Stroke
Technique
Thrombectomy
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
15 May 2024
15 May 2024
Historique:
received:
02
04
2024
accepted:
24
04
2024
medline:
22
5
2024
pubmed:
22
5
2024
entrez:
21
5
2024
Statut:
aheadofprint
Résumé
Endovascular treatment has become the standard care for acute basilar artery occlusion (BAO). Uncertainty persists about the optimal thrombectomy technique. To compare aspiration thrombectomy with stent retriever thrombectomy in patients with BAO in a multicenter real-world patient population. We analyzed data from the German Stroke Registry-Endovascular Treatment (GSR-ET). Patients with isolated BAO who underwent either aspiration or stent retriever thrombectomy were compared, including propensity score matching (PSM). The primary outcome measure was the modified Rankin Scale shift analysis at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), procedure complications, and metrics. Of 13 082 patients in the GSR-ET, 387 patients (mean age 72.0±13.1 years; 45.0% female) fulfilled the inclusion criteria. The thrombectomy technique was aspiration only in 195 (50.4%) and stent retriever only in 192 (49.6%) patients. Functional outcome did not differ between the groups, either before (common OR (cOR) 0.94; 95% CI 0.64 to 1.38) or after PSM (cOR=1.37; 95% CI 0.90 to 2.09). There was no significant difference in sICH (2.6 vs 5.5%; P=0.231; OR=0.46; 95% CI 0.14 to 1.47), but aspiration thrombectomy demonstrated fewer procedure-related complications (4.6% vs 12.5%; P=0.017), a shorter procedure duration (24 vs 48 min; P<0.001), and higher first pass recanalization rates (75.1% vs 44.8%; P<0.001). In this study both aspiration and stent retriever thrombectomy showed equal efficacy in terms of functional outcome in patients with BAO. However, procedure complications and metrics might favor aspiration over stent retriever thrombectomy.
Sections du résumé
BACKGROUND
BACKGROUND
Endovascular treatment has become the standard care for acute basilar artery occlusion (BAO). Uncertainty persists about the optimal thrombectomy technique.
OBJECTIVE
OBJECTIVE
To compare aspiration thrombectomy with stent retriever thrombectomy in patients with BAO in a multicenter real-world patient population.
METHODS
METHODS
We analyzed data from the German Stroke Registry-Endovascular Treatment (GSR-ET). Patients with isolated BAO who underwent either aspiration or stent retriever thrombectomy were compared, including propensity score matching (PSM). The primary outcome measure was the modified Rankin Scale shift analysis at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), procedure complications, and metrics.
RESULTS
RESULTS
Of 13 082 patients in the GSR-ET, 387 patients (mean age 72.0±13.1 years; 45.0% female) fulfilled the inclusion criteria. The thrombectomy technique was aspiration only in 195 (50.4%) and stent retriever only in 192 (49.6%) patients. Functional outcome did not differ between the groups, either before (common OR (cOR) 0.94; 95% CI 0.64 to 1.38) or after PSM (cOR=1.37; 95% CI 0.90 to 2.09). There was no significant difference in sICH (2.6 vs 5.5%; P=0.231; OR=0.46; 95% CI 0.14 to 1.47), but aspiration thrombectomy demonstrated fewer procedure-related complications (4.6% vs 12.5%; P=0.017), a shorter procedure duration (24 vs 48 min; P<0.001), and higher first pass recanalization rates (75.1% vs 44.8%; P<0.001).
CONCLUSIONS
CONCLUSIONS
In this study both aspiration and stent retriever thrombectomy showed equal efficacy in terms of functional outcome in patients with BAO. However, procedure complications and metrics might favor aspiration over stent retriever thrombectomy.
Identifiants
pubmed: 38772571
pii: jnis-2024-021797
doi: 10.1136/jnis-2024-021797
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Tobias BoeckhBehrens
(T)
Silke Wunderlich
(S)
Alexander Ludolph
(A)
Karl-Heinz Henn
(KH)
Arno Reich
(A)
Omid Nikoubashman
(O)
Ulrike Ernemann
(U)
Sven Poli
(S)
Christian H Nolte
(CH)
Eberhard Siebert
(E)
Sarah Zweynert
(S)
Georg Bohner
(G)
Gabor Petzold
(G)
Fee Keil
(F)
Joachim Röther
(J)
Bernd Eckert
(B)
Jörg Berrouschot
(J)
Albrecht Bormann
(A)
Anna Alegiani
(A)
Jens Fiehler
(J)
Christian Gerloff
(C)
Götz Thomalla
(G)
Christoffer Kraemer
(C)
Jan Liman
(J)
Martina Petersen
(M)
Florian Stögbauer
(F)
Michael Braun
(M)
Gerhard F Hamann
(GF)
Klaus Gröschel
(K)
Timo Uphaus
(T)
Jan Borggrefe
(J)
Franziska Dorn
(F)
Marielle Ernst
(M)
Jörg Hattingen
(J)
Hannes Leischner
(H)
Jan Hendrik Schäfer
(JH)
Maximilian Schell
(M)
Peter Schellinger
(P)
Christoph Trumm
(C)
Informations de copyright
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: LKel has received funding for travel or speaker honoraria from Alexion, AstraZeneca, Bayer Vital, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, and Pfizer outside of this study. CHN has received funding for travel or speaker honoraria from Alexion, Astra-Zeneca, Bayer Vital, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer, and Takeda.