Importance of Occlusion Site for Thrombectomy Technique in Stroke
Authors: Bernsen Marie Louise E. , Goldhoorn Robert-Jan B. , Lingsma Hester F. , van Oostenbrugge Robert J. , van Zwam Wim H. , Uyttenboogaart Maarten , Roos Yvo B.W.E.M. , Martens Jasper M. , Hofmeijer Jeannette , Dippel Diederik W.J. , van der Lugt Aad , Majoie Charles B.L.M. , Roos Yvo B.W.E.M. , van Oostenbrugge Robert J. , van Zwam Wim H. , Boiten Jelis , Albert Vos Jan , Jansen Ivo G.H. , Mulder Maxim J.H.L. , Goldhoorn Robert- Jan B. , Compagne Kars C.J. , Kappelhof Manon , Brouwer Josje , den Hartog Sanne J. , Hinsenveld Wouter H. , Dippel Diederik W.J. , Roozenbeek Bob , van der Lugt Aad , van Es Adriaan C.G.M. , Majoie Charles B.L.M. , Roos Yvo B.W.E.M. , Emmer Bart J. , Coutinho Jonathan M. , Schonewille Wouter J. , Albert Vos Jan , Wermer Marieke J.H. , van Walderveen Marianne A.A. , Staals Julie , van Oostenbrugge Robert J. , van Zwam Wim H. , Hofmeijer Jeannette , Martens Jasper M. , Lycklama Geert J. , Nijeholt à , Boiten Jelis , de Bruijn Sebastiaan F. , van Dijk Lukas C. , van der Worp H. Bart , Lo Rob H. , van Dijk Ewoud J. , Boogaarts Hieronymus D. , Vries J. de , de Kort Paul L.M. , van Tuijl Julia , Peluso Jo P. , Fransen Puck , van den Berg Jan S.P. , van Hasselt Boudewijn A.A.M. , Aerden Leo A.M. , Dallinga René J. , Uyttenboogaart Maarten , Eschgi Omid , Bokkers Reinoud P.H. , Schreuder Tobien H.C.M.L. , Heijboer Roel J.J. , Keizer Koos , Yo Lonneke S.F. , den Hertog Heleen M. , Bulut Tomas , Brouwers Paul J.A.M. , Majoie Charles B.L.M. , van Zwam Wim H. , van der Lugt Aad , Lycklama Geert J. , Nijeholt à , van Walderveen Marianne A.A. , Sprengers Marieke E.S. , Jenniskens Sjoerd F.M. , van den Berg René , Yoo Albert J. , Beenen Ludo F.M. , Postma Alida A. , Roosendaal Stefan D. , der Kallen Bas F.W. van , van den Wijngaard Ido R. , van Es Adriaan C.G.M. , Emmer Bart J. , Martens Jasper M. , Yo Lonneke S.F. , Albert Vos Jan , Bot Joost , van Doormaal Pieter-Jan , Meijer Anton , Ghariq Elyas , Bokkers Reinoud P.H. , van Proosdij Marc P. , Krietemeijer G. Menno , Peluso Jo P. , Boogaarts Hieronymus D. , Lo Rob , Gerrits Dick , Dinkelaar Wouter , Appelman Auke P.A. , Hammer Bas , Pegge Sjoert , van der Hoorn Anouk , Vinke Saman , Dippel Diederik W.J. , van der Lugt Aad , Majoie Charles B.L.M. , Roos Yvo B.W.E.M. , van Oostenbrugge Robert J. , van Zwam Wim H. , Lycklama Geert J. , Nijeholt à , Boiten Jelis , Albert Vos Jan , Schonewille Wouter J. , Hofmeijer Jeannette , Martens Jasper M. , van der Worp H. Bart , Lo Rob H. , van Oostenbrugge Robert J. , Hofmeijer Jeannette , Flach H. Zwenneke , Lingsma Hester F. , el Ghannouti Naziha , Sterrenberg Martin , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , Simons Michelle , Vossers Marjolein , de Meris Joke , Vermeulen Tamara , Geerlings Annet , van Vemde Gina , Simons Tiny , Messchendorp Gert , Nicolaij Nynke , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert Maureen , Verheesen Sabrina , Jeurrissen D. , Bos Erna , Drabbe Yvonne , Sandiman Michelle , Aaldering Nicoline , Zweedijk Berber , Vervoort Jocova , Ponjee Eva , Romviel Sharon , Kanselaar Karin , Barning Denn , Venema Esmee , Chalos Vicky , Geuskens Ralph R. , van Straaten Tim , Ergezen Saliha , Harmsma Roger R.M. , Muijres Daan , de Jong Anouk , Berkhemer Olvert A. , Boers Anna M.M. , Huguet J. , Groot P.F.C. , Mens Marieke A. , van Kranendonk Katinka R. , Treurniet Kilian M. , Tolhuisen Manon L. , Alves Heitor , Weterings Annick J. , Kirkels Eleonora L.F. , Voogd Eva J.H.F. , Schupp Lieve M. , Collette Sabine L. , Groot Adrien E.D. , LeCouffe Natalie E. , Konduri Praneeta R. , Prasetya Haryadi , Arrarte-Terreros Nerea , Ramos Lucas A. 
Published: December 2020

Background and Purpose:
Thrombectomy with stent retriever and direct aspiration are equally effective in the endovascular treatment of anterior circulation acute ischemic stroke. We report efficacy and safety of initial treatment technique per occlusion segment.

Methods:
For this study, we analyzed data from the MR CLEAN Registry, a prospective, observational study in all centers that perform endovascular therapy in the Netherlands. We used ordinal logistic regression analysis to compare clinical and technical results of first line direct aspiration treatment with that of stent retriever thrombectomy stratified for occlusion segment. Primary outcome measure was functional outcome at 3 months. Secondary outcome measures included reperfusion grade expressed as the extended Thrombolysis in Cerebral Infarction score, periprocedural complication risk, time to reperfusion, and mortality.

Results:

Of the 2282 included patients, 1658 (73%) were initially treated with stent retriever and 624 (27%) with aspiration. Four hundred sixty-two patients had an occlusion of the intracranial part of the carotid artery, 1349 of the proximal middle cerebral artery, and 471 of the distal parts of the middle cerebral artery. There was no difference in functional outcome between aspiration and stent retriever thrombectomy (odds ratio, 1.0 [95% CI, 0.9–1.2]) in any of the occlusion segments (
P
value for interaction=0.2). Reperfusion rate was higher in the aspiration group (odds ratio, 1.4 [95% CI, 1.1–1.6]) and did not differ between occlusion segments (
P
value for interaction=0.6). Procedure times were shorter in the aspiration group (minutes 50 versus 65 minutes;
P
<0.0001). There was no difference in periprocedural complications or mortality.

Conclusions:
In unselected patients with anterior circulation infarcts, we observed equal functional outcome of aspiration and stent retriever thrombectomy in all occlusion segments. When aspiration was the first line treatment modality, reperfusion rates were higher and procedure times shorter in all occlusion segments.