Neurology Today Conference Reporter: International Stroke Conference

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Monday, February 27, 2017

Direct Aspiration Found to Be as Effective as Stent Retriever for Recanalization of Head Clots

BY ED SUSMAN

HOUSTON—Direct contact aspiration of blood clots in acute cerebral infarction appears to work as well as stent retriever technology in recanalizing blocked arteries causing strokes, researchers reported here Wednesday at the 2017 International Stroke Conference sponsored by the American Heart Association/American Stroke Association.

The trial was not designed to compare the two methods of clot removal, however, but to determine if one sequence for first attacking the clot was superior to the other. The research team found that both techniques appeared to be equally successful no matter which method was used first.

"Mechanical thrombectomy with a stent retriever along with intravenous tissue plasminogen activator is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion," said Bertrand Lapergue, MD, PhD, the scientific coordinator of the ASTER (Adapt versus StEnt Retriever) study. "Treatment with stent retriever technology is good, but it is successful about 70 percent of the time. We think we can improve on that outcome," said Dr. Lapergue, a neurologist with the Stroke Center of Foch Hospital University Versailles in Saint-Quentin en Yvelines in France.

"The ASTER trial opens the door to add a new tool to remove the clot," he said. Preliminary studies using direct contact aspiration of the clot appeared promising, he added, "but we needed to do a controlled study to determine the true effectiveness of this technique."

The research team treated 192 patients first with direct aspiration and 189 with the stent retriever. The patients in the stent retriever group were about 68 years old, while the average age in the aspiration group was 72, a statistically significant difference (p=0.01). A higher percentage of patients in the aspiration group had hypertension (63.6 percent) compared with 58.6 percent of those in the stent retriever group (p=0.03); and19.5 percent of the patients in the aspiration group had experienced a previous stroke compared with 15.5 percent in the stent retriever group (p=0.03). Otherwise, the demographics and the medical histories of the two groups were similar.

Treatment with the stent retriever resulted in partial to complete perfusion — with a TICI (thrombolysis in cerebral infarction) Grade 2b/3 score — in 83.1 percent of the patients; the direct aspiration method had a similar success rate, 85.4 percent (p=0.53), a non-significant difference, said Dr. Lapergue.

The trial was supported by Penumbra, but the company did not participate in the study design or in the conclusions of the investigators, Dr. Lapergue said.

"The study is intriguing," said Ralph L. Sacco, MD, FAAN, FAHA, professor and chair of neurology and the Olemberg Family Chair in Neurological Disorders at the Miller School of Medicine at the University of Miami, who was not involved with the study. "This really does show for the first time that the aspiration device is probably as good and feasible at recanalization when compared with the stent retriever. It is important that the user be familiar and comfortable with the device. So its use may just come down to the preference of the interventionalist."

"I would like to see more of this work done in the United States," Dr. Sacco said, noting that differences may exist between the French population and people in the United States.

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