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Maïer B, Finitsis S, Bourcier R, et al. First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry. J Neurointerv Surg. 2021;doi: 10.1136/neurintsurg-2021-017505.
Maïer, B., Finitsis, S., Bourcier, R., Papanagiotou, P., Richard, S., Marnat, G., Sibon, I., Dargazanli, C., Arquizan, C., Blanc, R., Piotin, M., Lapergue, B., Consoli, A., Eugene, F., Vannier, S., Saleme, S., Macian, F., Clarençon, F., Rosso, C., Naggara, O., Turc, G., Viguier, A., Cognard, C., Wolff, V., Pop, R., Mazighi, M., Gory, B. (2021). First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry. Journal of neurointerventional surgery, . https://doi.org/10.1136/neurintsurg-2021-017505
Maïer, Benjamin, et al. "First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry." Journal of neurointerventional surgery vol. (2021). doi: https://doi.org/10.1136/neurintsurg-2021-017505
Maïer B, Finitsis S, Bourcier R, Papanagiotou P, Richard S, Marnat G, Sibon I, Dargazanli C, Arquizan C, Blanc R, Piotin M, Lapergue B, Consoli A, Eugene F, Vannier S, Saleme S, Macian F, Clarençon F, Rosso C, Naggara O, Turc G, Viguier A, Cognard C, Wolff V, Pop R, Mazighi M, Gory B. First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry. J Neurointerv Surg. 2021 May 10; doi: 10.1136/neurintsurg-2021-017505. Epub 2021 May 10. PMID: 33972458.
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J Neurointerv Surg. 2021 May 10; doi: 10.1136/neurintsurg-2021-017505. Epub 2021 May 10.

First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry.

Journal of neurointerventional surgery

Benjamin Maïer, Stephanos Finitsis, Romain Bourcier, Panagiotis Papanagiotou, Sébastien Richard, Gaultier Marnat, Igor Sibon, Cyril Dargazanli, Caroline Arquizan, Raphael Blanc, Michel Piotin, Bertrand Lapergue, Arturo Consoli, Francois Eugene, Stephane Vannier, Suzana Saleme, Francisco Macian, Frédéric Clarençon, Charlotte Rosso, Olivier Naggara, Guillaume Turc, Alain Viguier, Christophe Cognard, Valerie Wolff, Raoul Pop, Mikael Mazighi, Benjamin Gory,

Affiliations

  1. Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France [email protected].
  2. Université de Paris, Paris, Île-de-France, France.
  3. Department of Interventional Neuroradiology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece.
  4. Department of Interventional Neuroradiology, CHU Nantes, Nantes, Pays de la Loire, France.
  5. Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany.
  6. First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens - Aretaiio Hospital, Athens, Greece.
  7. Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France.
  8. Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France.
  9. Neurology Department, CHU de Bordeaux, Bordeaux, France.
  10. Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France.
  11. Department of Neurology, Hôpital Gui de Chauliac, Montpellier, Languedoc-Roussillon, France.
  12. Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, Île-de-France, France.
  13. Department of Neurology, Hospital Foch, Suresnes, Île-de-France, France.
  14. Department of Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.
  15. Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.
  16. Department of Radiology, CHU Rennes, Rennes, France.
  17. Department of Neurology, CHU Rennes, Rennes, Bretagne, France.
  18. Department of Interventional Neuroradiology, CHU Limoges, Limoges, Limousin, France.
  19. Department of Neurology, CHU Limoges, Limoges, France.
  20. Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France.
  21. Sorbonne University, Paris, Île-de-France, France.
  22. Urgences cérébro-vasculaires, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France.
  23. Department of Neuroradiology, Saint Anne Hospital Centre, Paris, Île-de-France, France.
  24. Department of Neurology, Saint Anne Hospital Centre, Paris, Île-de-France, France.
  25. Department of Neurology, CHU Toulouse, Toulouse, Occitanie, France.
  26. Department of Diagnostic and Therapeutic Neuroradiology, Hospital Purpan, Toulouse, Midi-Pyrénées, France.
  27. Stroke unit, University Hospitals Strasbourg, Strasbourg, Alsace, France.
  28. Department of Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France.
  29. Department of Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France.
  30. Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France.

PMID: 33972458 DOI: 10.1136/neurintsurg-2021-017505

Abstract

BACKGROUND: The best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA).

OBJECTIVE: To compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT.

METHODS: We analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0-2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes.

RESULTS: We included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA.

CONCLUSIONS: Despite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: catheter; device; stent; stroke; thrombectomy

Conflict of interest statement

Competing interests: None declared.

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