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J Stroke. 2018 May;20(2):268-276. English. Original Article. https://doi.org/10.5853/jos.2018.00192
Bourcier R , Mazighi M , Labreuche J , Fahed R , Blanc R , Gory B , Duhamel A , Marnat G , Saleme S , Costalat V , Bracard S , Desal H , Consoli A , Piotin M , Lapergue B , .
Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France. romain.bourcier2@gmail.com
Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France.
Department of Biostatistics, University Lille, CHRU Lille, Lille, France.
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France.
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France.
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France.
Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France.
Abstract

Background and Purpose

In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) was studied to determine its influence on trial results.

Methods

We included patients having undergone CA or SR for M1 or M2 occlusions, who were screened by MRI with T2* gradient recalled echo. Occlusions were classified as SVS (+) or SVS (–) in each randomization arm. Modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3 revascularization rates were recorded and clinical outcomes assessed by the overall distribution of modified Rankin scale (mRS) at 90 days.

Results

Among the 202 patients included, 143 patients were SVS (+) (70.8%; 95% confidence interval [CI], 64.5% to 77.1%). Overall, there was no difference in angiographic and clinical outcomes according to SVS status. However, compared to SR, CA achieved a lower mTICI 2c/3 rate in SVS (+) patients (risk ratio [RR] for CA vs. SR, 0.60; 95% CI, 0.51 to 0.71) but not in SVS (–) (RR, 1.11; 95% CI, 0.69 to 1.77; P for interaction=0.018). A significant heterogeneity in favor of superiority of first-line SR strategy in SVS (+) patients was also found regarding the overall mRS distribution (common odds ratio for CA vs. SR, 0.40 vs. 1.32; 95% CI, 0.21 to 0.74 in SVS (+) vs. 95% CI, 0.51 to 3.35 in SVS (–); P for interaction=0.038).

Conclusions

As a first line strategy, SR achieved higher recanalization rates and a more favourable clinical outcome at 3 months compared to CA when MRI shows SVS within the thrombus.

Copyright © 2019. Korean Association of Medical Journal Editors.