Contact Aspiration Equals Stent Retriever for Acute Stroke Care

The direct aspiration, first pass technique (ADAPT) for clearing large-vessel ischemic strokes is as safe and successful for reperfusion as a stent retriever, according to a new study.

Researchers at Foch Hospital, Lille University of Science and Technology, and other institutions conducted the prospective ADAPT versus StEnt Retriever (ASTER) study to compare the two strategies for treating patients with ischemic anterior circulation stroke secondary to large vessel occlusion (LVO). Patients who met criteria on imaging were randomized to either direct contact aspiration (192 patients), or to mechanical thrombectomy with a stent retriever (189 patients) as first-line treatment, with a switch to other therapy allowed after three failed attempts.

The primary outcome was successful recanalization, with secondary outcomes including initial successful use of the assigned treatment technique, overall procedural times, complications, and modified Rankin Scale (mRS) at three month. The results showed that the rate of successful recanalization at the end of the treatment was 85.4% with ADAPT using the Penumbra stroke system aspiration catheter, compared to 83.1% with stent retriever as the first-line strategy.

In addition, 63% of the patients treated with ADAPT achieved the three month secondary endpoints, compared to 67.7% of the patients treated with stent retrievers. All safety endpoints, including new embolization or infarct, arterial perforation, arterial dissection, vasospasm, and intracranial or subarachnoid hemorrhage were similar between treatment strategies. The study was presented at the International Stroke Conference, held during February 2017 in Houston (TX, USA).

“There are no significant difference in revascularization rate and safety using either thrombectomy technique with Penumbra aspiration and stent retrievers for acute ischemic stroke patients with large vessel occlusions," said lead author Bertrand Lapergue, MD, PhD, of the stroke center at Foch Hospital. “The broad eligibility criteria achieved make the ASTER results generalizable to the majority of stroke patients with large vessel occlusions.”

Stent retrievers are deployed in an occluded vessel and are temporarily expanded into the body of a thrombus in order to recanalize the vessel, allowing for reperfusion of ischemic sites and causing the thrombus to be partially entangled within the stent. Thrombectomy is then performed by retracting the stent.