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Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER Randomized Clinical Trial.

Abstract The benefits of endovascular revascularization using the contact aspiration technique vs the stent retriever technique in patients with acute ischemic stroke remain uncertain because of lack of evidence from randomized trials.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title jama
Publication Year Start




PMID- 28763550
OWN - NLM
STAT- In-Process
DA  - 20170801
LR  - 20170801
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 318
IP  - 5
DP  - 2017 Aug 01
TI  - Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization
      in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER
      Randomized Clinical Trial.
PG  - 443-452
LID - 10.1001/jama.2017.9644 [doi]
AB  - Importance: The benefits of endovascular revascularization using the contact
      aspiration technique vs the stent retriever technique in patients with acute
      ischemic stroke remain uncertain because of lack of evidence from randomized
      trials. Objective: To compare efficacy and adverse events using the contact
      aspiration technique vs the standard stent retriever technique as a first-line
      endovascular treatment for successful revascularization among patients with acute
      ischemic stroke and large vessel occlusion. Design, Setting, and Participants:
      The Contact Aspiration vs Stent Retriever for Successful Revascularization
      (ASTER) study was a randomized, open-label, blinded end-point clinical trial
      conducted in 8 comprehensive stroke centers in France (October 2015-October
      2016). Patients who presented with acute ischemic stroke and a large vessel
      occlusion in the anterior circulation within 6 hours of symptom onset were
      included. Interventions: Patients were randomly assigned to first-line contact
      aspiration (n = 192) or first-line stent retriever (n = 189) immediately prior to
      mechanical thrombectomy. Main Outcomes and Measures: The primary outcome was the 
      proportion of patients with successful revascularization defined as a modified
      Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all
      endovascular procedures. Secondary outcomes included degree of disability
      assessed by overall distribution of the modified Rankin Scale (mRS) score at 90
      days, change in National Institutes of Health Stroke Scale (NIHSS) score at 24
      hours, all-cause mortality at 90 days, and procedure-related serious adverse
      events. Results: Among 381 patients randomized (mean age, 69.9 years; 174 women
      [45.7%]), 363 (95.3%) completed the trial. Median time from symptom onset to
      arterial puncture was 227 minutes (interquartile range, 180-280 minutes). For the
      primary outcome, the proportion of patients with successful revascularization was
      85.4% (n = 164) in the contact aspiration group vs 83.1% (n = 157) in the stent
      retriever group (odds ratio, 1.20 [95% CI, 0.68-2.10]; P = .53; difference, 2.4% 
      [95% CI, -5.4% to 9.7%]). For the clinical efficacy outcomes (change in NIHSS
      score at 24 hours, mRS score at 90 days) and adverse events, there were no
      significant differences between groups. Conclusions and Relevance: Among patients
      with ischemic stroke in the anterior circulation undergoing thrombectomy,
      first-line thrombectomy with contact aspiration compared with stent retriever did
      not result in an increased successful revascularization rate at the end of the
      procedure. Trial Registration: clinicaltrials.gov Identifier: NCT02523261.
FAU - Lapergue, Bertrand
AU  - Lapergue B
AD  - Department of Stroke Center and Diagnostic and Interventional Neuroradiology,
      University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, 
      France.
FAU - Blanc, Raphael
AU  - Blanc R
AD  - Department of Diagnostic and Interventional Neuroradiology, Rothschild
      Foundation, Paris, France.
FAU - Gory, Benjamin
AU  - Gory B
AD  - Department of Diagnostic and Interventional Neuroradiology, Hospices Civils de
      Lyon, Bron, France.
FAU - Labreuche, Julien
AU  - Labreuche J
AD  - University Lille, CHU Lille, Department of Biostatistics, EA 2694-Sante Publique:
      Epidemiologie et Qualite des Soins, Lille, France.
FAU - Duhamel, Alain
AU  - Duhamel A
AD  - University Lille, CHU Lille, Department of Biostatistics, EA 2694-Sante Publique:
      Epidemiologie et Qualite des Soins, Lille, France.
FAU - Marnat, Gautier
AU  - Marnat G
AD  - Department of Diagnostic and Interventional Neuroradiology, University Hospital
      of Bordeaux, Bordeaux, France.
FAU - Saleme, Suzana
AU  - Saleme S
AD  - Department of Diagnostic and Interventional Neuroradiology, University Hospital
      of Limoges, Limoges, France.
FAU - Costalat, Vincent
AU  - Costalat V
AD  - Department of Diagnostic and Interventional Neuroradiology, Hopital Gui de
      Chauliac, Montpellier, France.
FAU - Bracard, Serge
AU  - Bracard S
AD  - Department of Diagnostic and Interventional Neuroradiology, University Hospital
      of Nancy, Nancy, France.
FAU - Desal, Hubert
AU  - Desal H
AD  - Department of Diagnostic and Interventional Neuroradiology, Guillaume et Rene
      Laennec University Hospital, Nantes, France.
FAU - Mazighi, Mikael
AU  - Mazighi M
AD  - Department of Diagnostic and Interventional Neuroradiology, Rothschild
      Foundation, Paris, France.
FAU - Consoli, Arturo
AU  - Consoli A
AD  - Department of Stroke Center and Diagnostic and Interventional Neuroradiology,
      University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, 
      France.
FAU - Piotin, Michel
AU  - Piotin M
AD  - Department of Diagnostic and Interventional Neuroradiology, Rothschild
      Foundation, Paris, France.
CN  - ASTER Trial Investigators
LA  - eng
PT  - Journal Article
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
EDAT- 2017/08/02 06:00
MHDA- 2017/08/02 06:00
CRDT- 2017/08/02 06:00
AID - 2646719 [pii]
AID - 10.1001/jama.2017.9644 [doi]
PST - ppublish
SO  - JAMA. 2017 Aug 1;318(5):443-452. doi: 10.1001/jama.2017.9644.