J Stroke.
2018 May;20(2):268-276. 10.5853/jos.2018.00192.
Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration
- Affiliations
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- 1Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France. romain.bourcier2@gmail.com
- 2Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France.
- 3Department of Biostatistics, University Lille, CHRU Lille, Lille, France.
- 4Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France.
- 5Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
- 6Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France.
- 7Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France.
- 8Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France.
- KMID: 2424430
- DOI: http://doi.org/10.5853/jos.2018.00192
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.
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