Outcomes for contact aspiration and stent retrievers shown to be similar according to the admission clot burden score

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The post-hoc analysis of the contact aspiration versus stent retriever for successful revascularisation (ASTER) trial showed that the clot burden score on admission was found to be a reliable indicator of 90-day clinical outcome. No difference was observed between contact aspiration and stent retriever use as first line strategies.

This confirms the results from the original ASTER data. It had previously been shown that there is a relationship between clot burden score and recanalisation success but mainly for intravenous thrombolysis.

Novel thrombectomy techniques, such as contact aspiration, have diversified endovascular approaches and raised the question of what the best approach for treating acute ischaemic strokes with a large clot burden is. This study set out to comparatively asses and compare the efficiency of these two different techniques (contact aspiration and stent retriever) and evaluated the efficiency of mechanical thrombectomy according to the clot burden score.

Using the clot burden score provides physicians with an additional marker to help them predict clinical outcomes. The clot burden score is evaluated at admission on computed tomography (CT) or magnetic resonance image (MRI) and characterises the intracranial arterial thrombus extent.

The study included 231 randomised patients, of which almost half of the patients (114) had a clot burden score of 0–6 and 117 had a clot burden score of 7 or more.

The results showed a higher rate of reperfusion and 90-day favourable outcome after mechanical thrombectomy for small thrombus burden, defined as clot burden score of 7 or more. Similar angiographic and clinical outcomes were observed after the first-line strategy and at the end of all procedures with stent retriever and contact aspiration for both small and large thrombus burdens (clot burden score 0–6 and ≥7).

Combined therapy with stent retriever and aspiration therapy in first line strategy will be evaluated in the ASTER 2 (Combined Use of Contact Aspiration and the Stent Retriever Technique Versus Stent Retriever Alone for Recanalisation in Acute Cerebral Infarction) trial, which is finish inclusion recently, aiming to show the superiority of combining the use of contact aspiration with a stent retriever, compared to using  a stent retriever alone for the treatment of acute ischaemic stroke with an aimed study completion date of 2020

The findings were published in Stroke.

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