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J Stroke. 2018 May;20(2):268-276. doi: 10.5853/jos.2018.00192. Epub 2018 May 31.

Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.

Author information

1
Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
2
Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France.
3
Department of Biostatistics, University Lille, CHRU Lille, Lille, France.
4
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France.
5
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
6
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France.
7
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France.
8
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.

KEYWORDS:

Aspiration catheter; Retrieval device; Thrombectomy; Thrombosis

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