Clinical and Angiographic Outcomes with the Combined Local Aspiration and Retriever in the North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry

Tim W Malisch, Osama O Zaidat, Alicia C Castonguay, Franklin A Marden, Rishi Gupta, Chung-Huan J Sun, Coleman O Martin, William E Holloway, Nils Mueller-Kronast, Joey English, Italo Linfante, Guilherme Dabus, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Michael Froehler, Aamir Badruddin, Thanh N Nguyen, M Asif Taqi, Michael G Abraham, Vallabh Janardhan, Hashem Shaltoni, Robin Novakovic, Albert J Yoo, Alex Abou-Chebl, Peng Roc Chen, Gavin W Britz, Ritesh Kaushal, Ashish Nanda, Raul G Nogueira, Tim W Malisch, Osama O Zaidat, Alicia C Castonguay, Franklin A Marden, Rishi Gupta, Chung-Huan J Sun, Coleman O Martin, William E Holloway, Nils Mueller-Kronast, Joey English, Italo Linfante, Guilherme Dabus, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Michael Froehler, Aamir Badruddin, Thanh N Nguyen, M Asif Taqi, Michael G Abraham, Vallabh Janardhan, Hashem Shaltoni, Robin Novakovic, Albert J Yoo, Alex Abou-Chebl, Peng Roc Chen, Gavin W Britz, Ritesh Kaushal, Ashish Nanda, Raul G Nogueira

Abstract

Background: Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry.

Summary: Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC, p = 0.04 and 26% in CGC, p = 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with CGC (54 vs. 91 min, p = 0.001) and was comparable to the BGC time (54 vs. 67, p = 0.11). Final degree of reperfusion was comparable among the groups (TICI [modified Thrombolysis in Cerebral Infarction] score 2b or higher was 72 vs. 70% for CGC vs. 78% for BGC). Procedural complications, mortality, and good clinical outcome at 90 days were similar between the groups.

Key messages: The ARTS mechanical thrombectomy in acute ischemic stroke patients appears to yield better results as compared to the use of CGCs with no significant difference when compared to BGC. This early ARTS technique NASA registry data are limited by the earlier generation distal large bore catheters and small sample size. Future studies should focus on the comparison of ARTS and BGC techniques.

Keywords: Aspiration technique; Stent retriever; Stroke; Thrombectomy.

Figures

Fig. 1
Fig. 1
ARTS NASA substudy flow chart.
Fig. 2
Fig. 2
a Illustrative case of mechanical thrombectomy with stent-retriever (MTSR) with local aspiration (LA) technique showing complete recanalization of the dominant right MCA inferior division occlusion. Pre-MTSR image, arrow indicates site of occlusion. MTSR with LA image, arrows (inferior to superior) indicate tip of base catheter, tip of local aspiration catheter, and tip of stent retriever. b Illustration of the ARTS technique.

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