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Benjamin Gory - One of the best experts on this subject based on the ideXlab platform.

  • first pass effect with contact aspiration and Stent Retrievers in the aspiration versus Stent Retriever aster trial
    Journal of NeuroInterventional Surgery, 2020
    Co-Authors: Celina Ducroux, Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Malek Ben Maacha, Bertrand Lapergue, Robert Fahed
    Abstract:

    Background The ‘first pass effect’ (FPE), which was originally described with Stent Retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality. Objective We report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial. Materials and methods ASTER is a randomized trial comparing angiographic revascularization with the Stent Retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients. Results FPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients. Conclusion In the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted. Trial registration number Unique identifier: NCT02523261.

  • Supplemental material for First-line contact aspiration vs Stent-Retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis
    2019
    Co-Authors: Marion Boulanger, Michel Piotin, Bertrand Lapergue, Francis Turjman, Serge Bracard, Emmanuel Touzé, René Anxionnat, Benjamin Gory
    Abstract:

    Supplemental Material for First-line contact aspiration vs Stent-Retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis by Marion Boulanger, Bertrand Lapergue, Francis Turjman, Emmanuel Touzé, René Anxionnat, Serge Bracard, Michel Piotin and Benjamin Gory in Interventional Neuroradiology

  • mechanical thrombectomy in basilar artery occlusion influence of reperfusion on clinical outcome and impact of the first line strategy adapt vs Stent Retriever
    Journal of Neurosurgery, 2018
    Co-Authors: Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Francis Turjman, Mikael Mazighi, Bertrand Lapergue
    Abstract:

    OBJECTIVESeveral randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with Stent Retriever devices.METHODSThree comprehensive stroke centers prospectively collected individual data from BAO patients treated with MT. Baseline characteristics as well as radiographic and clinical outcomes were compared between the 2 MT strategies. The primary outcome measure was the rate of successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2b-3. Favorable outcome was defined as a 90-day modified Rankin Scale score of 0-2.RESULTSAmong the 100 adult patients included in the study, 46 were treated with first-line ADAPT (median age 61 years, IQR 53-71 years; Stent-Retriever rescue therapy was secondarily used in 12 [26.1%]) and 54 were treated with a primary Stent Retriever (median age 67 years, IQR 53-78 years). There was no difference in baseline characteristics between the 2 treatment groups, except for the rate of diabetes (19.6% vs 5.7%, respectively, p = 0.035). Successful reperfusion was achieved in 79% of the overall study sample. Overall, the rate of favorable outcome was 36.8% and 90-day all-cause mortality was 44.2%. Successful reperfusion positively impacted favorable outcome (OR 4.57, 95% CI 1.24-16.87, p = 0.023). A nonsignificant trend toward a higher successful reperfusion rate (unadjusted OR 2.56, 95% CI 0.90-7.29, p = 0.071) and a significantly higher rate of complete reperfusion (mTICI grade 3; unadjusted OR 2.59, 95% CI 1.14-5.86, p = 0.021) was found in the ADAPT group. The procedure duration was also significantly lower in the ADAPT group (median 45 minutes, IQR 34 to 62 minutes vs 56 minutes, IQR 40 to 90 minutes; p = 0.05), as was the rate of periprocedural complications (4.3% vs 25.9%, p = 0.003). Symptomatic intracranial hemorrhage (0.0% vs 4.0%, p = 0.51) and 90-day all-cause mortality (46.7% vs 42.0%, p = 0.65) were similar in the 2 groups.CONCLUSIONSAmong BAO patients, successful reperfusion is a strong predictor of a 90-day favorable outcome, and the choice of ADAPT as the first-line strategy achieves a significantly higher rate of complete reperfusion with a shorter procedure duration.

  • abstract 157 contact aspiration versus Stent Retriever for large vessel occlusion in the anterior circulation within six hours of symptom onset effect of mothership versus drip and ship paradigms in the aster trial
    Stroke, 2018
    Co-Authors: Michel Piotin, Benjamin Gory, Julien Labreuche, Raphael Blanc, Alain Duhamel, Vincent Costalat, Suzana Saleme, Gauthier Marnat, S Bracard, Hubert Desal
    Abstract:

    Purpose: The ASTER trial (contact Aspiration versus Stent Retriever for revascularization in patients presenting with acute ischemic stroke and a large vessel occlusion in the anterior circulation ...

  • Susceptibility vessel sign in the aster trial: higher recanalization rate and more favourable clinical outcome after first line Stent Retriever compared to contact aspiration
    Journal of Stroke, 2018
    Co-Authors: Romain Bourcier, Benjamin Gory, Julien Labreuche, Raphael Blanc, Robert Fahed, Alain Duhamel, Mikael Mazighi, Gaultier Marnat, Suzana Saleme, Vincent Costalat
    Abstract:

    OBJECTIVE: 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* 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; PP 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.

Julien Labreuche - One of the best experts on this subject based on the ideXlab platform.

  • first pass effect with contact aspiration and Stent Retrievers in the aspiration versus Stent Retriever aster trial
    Journal of NeuroInterventional Surgery, 2020
    Co-Authors: Celina Ducroux, Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Malek Ben Maacha, Bertrand Lapergue, Robert Fahed
    Abstract:

    Background The ‘first pass effect’ (FPE), which was originally described with Stent Retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality. Objective We report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial. Materials and methods ASTER is a randomized trial comparing angiographic revascularization with the Stent Retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients. Results FPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients. Conclusion In the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted. Trial registration number Unique identifier: NCT02523261.

  • susceptibility vessel sign on mri predicts better clinical outcome in patients with anterior circulation acute stroke treated with Stent Retriever as first line strategy
    Journal of NeuroInterventional Surgery, 2019
    Co-Authors: Romain Bourcier, Julien Labreuche, Raphael Blanc, Sebastien Soize, Maeva Kyheng, Wagih Ben Hassen, Pascal Roux, Marie Tisserand, Charlotte Rosso, Michel Piotin
    Abstract:

    Background Susceptibility vessel sign (SVS) can be a useful MRI biomarker of an occlusion but its relationship with clinical outcomes of acute ischemic stroke (AIS) is yet to be fully elucidated. Objective To investigate SVS in relation to the clinical outcomes after mechanical thrombectomy using a Stent Retriever (SR) as first-line approach in patients with AIS. Material and methods We included patients with a first-line SR approach for anterior AIS from the the Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) and THRombectomie des Arteres CErebrales (THRACE) trials when both baseline imaging of SVS and 90-day modified Rankin Scale (mRS) scores were available. Patients were assigned to two groups based on the presence of an SVS (independent core laboratory), and the overall distributions of the mRS score at 90 days (shift analysis) and clinical independence (mRS score ≤2) were compared. Results 217 patients were included and SVS was diagnosed in 76.0% of cases (n=165, 95% CI 70.4% to 81.7%). After adjustment for potential confounders, SVS+ was significantly associated with 90-day mRS improvement (adjusted common OR=2.75; 95% CI 1.44 to 5.26) and favorable outcome (adjusted common OR=2.76; 95% CI 1.18 to 6.45). Conclusion Based on results for patients of the ASTER and THRACE trials receiving first-line SR treatment, SVS was associated with lower disability at 3 months. Large prospective studies using MRI-based thrombus evaluation are warranted.

  • mechanical thrombectomy in basilar artery occlusion influence of reperfusion on clinical outcome and impact of the first line strategy adapt vs Stent Retriever
    Journal of Neurosurgery, 2018
    Co-Authors: Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Francis Turjman, Mikael Mazighi, Bertrand Lapergue
    Abstract:

    OBJECTIVESeveral randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with Stent Retriever devices.METHODSThree comprehensive stroke centers prospectively collected individual data from BAO patients treated with MT. Baseline characteristics as well as radiographic and clinical outcomes were compared between the 2 MT strategies. The primary outcome measure was the rate of successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2b-3. Favorable outcome was defined as a 90-day modified Rankin Scale score of 0-2.RESULTSAmong the 100 adult patients included in the study, 46 were treated with first-line ADAPT (median age 61 years, IQR 53-71 years; Stent-Retriever rescue therapy was secondarily used in 12 [26.1%]) and 54 were treated with a primary Stent Retriever (median age 67 years, IQR 53-78 years). There was no difference in baseline characteristics between the 2 treatment groups, except for the rate of diabetes (19.6% vs 5.7%, respectively, p = 0.035). Successful reperfusion was achieved in 79% of the overall study sample. Overall, the rate of favorable outcome was 36.8% and 90-day all-cause mortality was 44.2%. Successful reperfusion positively impacted favorable outcome (OR 4.57, 95% CI 1.24-16.87, p = 0.023). A nonsignificant trend toward a higher successful reperfusion rate (unadjusted OR 2.56, 95% CI 0.90-7.29, p = 0.071) and a significantly higher rate of complete reperfusion (mTICI grade 3; unadjusted OR 2.59, 95% CI 1.14-5.86, p = 0.021) was found in the ADAPT group. The procedure duration was also significantly lower in the ADAPT group (median 45 minutes, IQR 34 to 62 minutes vs 56 minutes, IQR 40 to 90 minutes; p = 0.05), as was the rate of periprocedural complications (4.3% vs 25.9%, p = 0.003). Symptomatic intracranial hemorrhage (0.0% vs 4.0%, p = 0.51) and 90-day all-cause mortality (46.7% vs 42.0%, p = 0.65) were similar in the 2 groups.CONCLUSIONSAmong BAO patients, successful reperfusion is a strong predictor of a 90-day favorable outcome, and the choice of ADAPT as the first-line strategy achieves a significantly higher rate of complete reperfusion with a shorter procedure duration.

  • Similar Outcomes for Contact Aspiration and Stent Retriever Use According to the Admission Clot Burden Score in ASTER
    Stroke, 2018
    Co-Authors: François Zhu, Julien Labreuche, Raphael Blanc, Bertrand Lapergue, Alain Duhamel, Gautier Marnat, Suzana Saleme, Maeva Kyheng, Malek Ben Machaa, Vincent Costalat
    Abstract:

    BACKGROUND AND PURPOSE: The clot burden score (CBS) at admission reliably evaluates the thrombus burden in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy has been diversified, especially with contact aspiration technique, and its efficiency with respect to the thrombus burden is not known. We compared reperfusion, adverse events, neurological recovery, and 90-day functional outcome of Stent Retriever use versus contact aspiration according to the admission CBS. METHODS: This is a post hoc analysis of the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) randomized trial. The primary outcome was successful reperfusion after all procedures, defined as modified Thrombolysis in Cerebral Infarction scores 2b/3. Secondary outcomes were 90-day functional outcome, assessed with the modified Rankin Scale. Safety outcomes included 90-day mortality and any intracerebral hemorrhage. RESULTS: A total of 231 randomized patients were included in this study: 114 patients had a CBS of 0 to 6 and 117 a CBS ≥7 at admission. Successful reperfusion at procedure end was achieved more frequently in patients with CBS ≥7 (88.9%) than patients with a CBS 0 to 6 (81.6%; fully adjusted risk ratio, 1.09; 95% confidence interval, 1.01-1.28). Favorable outcome (modified Rankin Scale score, 0-2) at 90 days was achieved in significantly more patients with CBS ≥7 (61.9%) than in patients with CBS 0 to 6 (41.8%; fully adjusted risk ratio, 1.19; 95% confidence interval, 1.02-1.40). No outcome differences of first-line mechanical thrombectomy strategy (aspiration versus Stent) on any angiographic or clinical outcomes were observed between the 2 groups. We also found no evidence of interaction between first-line mechanical thrombectomy strategy and CBS groups regarding safety. CONCLUSIONS: First-line mechanical thrombectomy with contact aspiration compared with Stent Retriever did not result in an increased successful reperfusion rate in acute ischemic stroke patients with large vessel occlusion of the anterior circulation according to the admission CBS. The latter, however, seems to be a reliable prognostic indicator of angiographic and clinical outcome.

  • abstract 157 contact aspiration versus Stent Retriever for large vessel occlusion in the anterior circulation within six hours of symptom onset effect of mothership versus drip and ship paradigms in the aster trial
    Stroke, 2018
    Co-Authors: Michel Piotin, Benjamin Gory, Julien Labreuche, Raphael Blanc, Alain Duhamel, Vincent Costalat, Suzana Saleme, Gauthier Marnat, S Bracard, Hubert Desal
    Abstract:

    Purpose: The ASTER trial (contact Aspiration versus Stent Retriever for revascularization in patients presenting with acute ischemic stroke and a large vessel occlusion in the anterior circulation ...

Raphael Blanc - One of the best experts on this subject based on the ideXlab platform.

  • first pass effect with contact aspiration and Stent Retrievers in the aspiration versus Stent Retriever aster trial
    Journal of NeuroInterventional Surgery, 2020
    Co-Authors: Celina Ducroux, Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Malek Ben Maacha, Bertrand Lapergue, Robert Fahed
    Abstract:

    Background The ‘first pass effect’ (FPE), which was originally described with Stent Retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality. Objective We report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial. Materials and methods ASTER is a randomized trial comparing angiographic revascularization with the Stent Retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients. Results FPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients. Conclusion In the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted. Trial registration number Unique identifier: NCT02523261.

  • susceptibility vessel sign on mri predicts better clinical outcome in patients with anterior circulation acute stroke treated with Stent Retriever as first line strategy
    Journal of NeuroInterventional Surgery, 2019
    Co-Authors: Romain Bourcier, Julien Labreuche, Raphael Blanc, Sebastien Soize, Maeva Kyheng, Wagih Ben Hassen, Pascal Roux, Marie Tisserand, Charlotte Rosso, Michel Piotin
    Abstract:

    Background Susceptibility vessel sign (SVS) can be a useful MRI biomarker of an occlusion but its relationship with clinical outcomes of acute ischemic stroke (AIS) is yet to be fully elucidated. Objective To investigate SVS in relation to the clinical outcomes after mechanical thrombectomy using a Stent Retriever (SR) as first-line approach in patients with AIS. Material and methods We included patients with a first-line SR approach for anterior AIS from the the Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) and THRombectomie des Arteres CErebrales (THRACE) trials when both baseline imaging of SVS and 90-day modified Rankin Scale (mRS) scores were available. Patients were assigned to two groups based on the presence of an SVS (independent core laboratory), and the overall distributions of the mRS score at 90 days (shift analysis) and clinical independence (mRS score ≤2) were compared. Results 217 patients were included and SVS was diagnosed in 76.0% of cases (n=165, 95% CI 70.4% to 81.7%). After adjustment for potential confounders, SVS+ was significantly associated with 90-day mRS improvement (adjusted common OR=2.75; 95% CI 1.44 to 5.26) and favorable outcome (adjusted common OR=2.76; 95% CI 1.18 to 6.45). Conclusion Based on results for patients of the ASTER and THRACE trials receiving first-line SR treatment, SVS was associated with lower disability at 3 months. Large prospective studies using MRI-based thrombus evaluation are warranted.

  • mechanical thrombectomy in basilar artery occlusion influence of reperfusion on clinical outcome and impact of the first line strategy adapt vs Stent Retriever
    Journal of Neurosurgery, 2018
    Co-Authors: Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Francis Turjman, Mikael Mazighi, Bertrand Lapergue
    Abstract:

    OBJECTIVESeveral randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with Stent Retriever devices.METHODSThree comprehensive stroke centers prospectively collected individual data from BAO patients treated with MT. Baseline characteristics as well as radiographic and clinical outcomes were compared between the 2 MT strategies. The primary outcome measure was the rate of successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2b-3. Favorable outcome was defined as a 90-day modified Rankin Scale score of 0-2.RESULTSAmong the 100 adult patients included in the study, 46 were treated with first-line ADAPT (median age 61 years, IQR 53-71 years; Stent-Retriever rescue therapy was secondarily used in 12 [26.1%]) and 54 were treated with a primary Stent Retriever (median age 67 years, IQR 53-78 years). There was no difference in baseline characteristics between the 2 treatment groups, except for the rate of diabetes (19.6% vs 5.7%, respectively, p = 0.035). Successful reperfusion was achieved in 79% of the overall study sample. Overall, the rate of favorable outcome was 36.8% and 90-day all-cause mortality was 44.2%. Successful reperfusion positively impacted favorable outcome (OR 4.57, 95% CI 1.24-16.87, p = 0.023). A nonsignificant trend toward a higher successful reperfusion rate (unadjusted OR 2.56, 95% CI 0.90-7.29, p = 0.071) and a significantly higher rate of complete reperfusion (mTICI grade 3; unadjusted OR 2.59, 95% CI 1.14-5.86, p = 0.021) was found in the ADAPT group. The procedure duration was also significantly lower in the ADAPT group (median 45 minutes, IQR 34 to 62 minutes vs 56 minutes, IQR 40 to 90 minutes; p = 0.05), as was the rate of periprocedural complications (4.3% vs 25.9%, p = 0.003). Symptomatic intracranial hemorrhage (0.0% vs 4.0%, p = 0.51) and 90-day all-cause mortality (46.7% vs 42.0%, p = 0.65) were similar in the 2 groups.CONCLUSIONSAmong BAO patients, successful reperfusion is a strong predictor of a 90-day favorable outcome, and the choice of ADAPT as the first-line strategy achieves a significantly higher rate of complete reperfusion with a shorter procedure duration.

  • Similar Outcomes for Contact Aspiration and Stent Retriever Use According to the Admission Clot Burden Score in ASTER
    Stroke, 2018
    Co-Authors: François Zhu, Julien Labreuche, Raphael Blanc, Bertrand Lapergue, Alain Duhamel, Gautier Marnat, Suzana Saleme, Maeva Kyheng, Malek Ben Machaa, Vincent Costalat
    Abstract:

    BACKGROUND AND PURPOSE: The clot burden score (CBS) at admission reliably evaluates the thrombus burden in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy has been diversified, especially with contact aspiration technique, and its efficiency with respect to the thrombus burden is not known. We compared reperfusion, adverse events, neurological recovery, and 90-day functional outcome of Stent Retriever use versus contact aspiration according to the admission CBS. METHODS: This is a post hoc analysis of the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) randomized trial. The primary outcome was successful reperfusion after all procedures, defined as modified Thrombolysis in Cerebral Infarction scores 2b/3. Secondary outcomes were 90-day functional outcome, assessed with the modified Rankin Scale. Safety outcomes included 90-day mortality and any intracerebral hemorrhage. RESULTS: A total of 231 randomized patients were included in this study: 114 patients had a CBS of 0 to 6 and 117 a CBS ≥7 at admission. Successful reperfusion at procedure end was achieved more frequently in patients with CBS ≥7 (88.9%) than patients with a CBS 0 to 6 (81.6%; fully adjusted risk ratio, 1.09; 95% confidence interval, 1.01-1.28). Favorable outcome (modified Rankin Scale score, 0-2) at 90 days was achieved in significantly more patients with CBS ≥7 (61.9%) than in patients with CBS 0 to 6 (41.8%; fully adjusted risk ratio, 1.19; 95% confidence interval, 1.02-1.40). No outcome differences of first-line mechanical thrombectomy strategy (aspiration versus Stent) on any angiographic or clinical outcomes were observed between the 2 groups. We also found no evidence of interaction between first-line mechanical thrombectomy strategy and CBS groups regarding safety. CONCLUSIONS: First-line mechanical thrombectomy with contact aspiration compared with Stent Retriever did not result in an increased successful reperfusion rate in acute ischemic stroke patients with large vessel occlusion of the anterior circulation according to the admission CBS. The latter, however, seems to be a reliable prognostic indicator of angiographic and clinical outcome.

  • abstract 157 contact aspiration versus Stent Retriever for large vessel occlusion in the anterior circulation within six hours of symptom onset effect of mothership versus drip and ship paradigms in the aster trial
    Stroke, 2018
    Co-Authors: Michel Piotin, Benjamin Gory, Julien Labreuche, Raphael Blanc, Alain Duhamel, Vincent Costalat, Suzana Saleme, Gauthier Marnat, S Bracard, Hubert Desal
    Abstract:

    Purpose: The ASTER trial (contact Aspiration versus Stent Retriever for revascularization in patients presenting with acute ischemic stroke and a large vessel occlusion in the anterior circulation ...

Bertrand Lapergue - One of the best experts on this subject based on the ideXlab platform.

  • first pass effect with contact aspiration and Stent Retrievers in the aspiration versus Stent Retriever aster trial
    Journal of NeuroInterventional Surgery, 2020
    Co-Authors: Celina Ducroux, Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Malek Ben Maacha, Bertrand Lapergue, Robert Fahed
    Abstract:

    Background The ‘first pass effect’ (FPE), which was originally described with Stent Retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality. Objective We report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial. Materials and methods ASTER is a randomized trial comparing angiographic revascularization with the Stent Retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients. Results FPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients. Conclusion In the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted. Trial registration number Unique identifier: NCT02523261.

  • Supplemental material for First-line contact aspiration vs Stent-Retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis
    2019
    Co-Authors: Marion Boulanger, Michel Piotin, Bertrand Lapergue, Francis Turjman, Serge Bracard, Emmanuel Touzé, René Anxionnat, Benjamin Gory
    Abstract:

    Supplemental Material for First-line contact aspiration vs Stent-Retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis by Marion Boulanger, Bertrand Lapergue, Francis Turjman, Emmanuel Touzé, René Anxionnat, Serge Bracard, Michel Piotin and Benjamin Gory in Interventional Neuroradiology

  • mechanical thrombectomy in basilar artery occlusion influence of reperfusion on clinical outcome and impact of the first line strategy adapt vs Stent Retriever
    Journal of Neurosurgery, 2018
    Co-Authors: Benjamin Gory, Julien Labreuche, Michel Piotin, Raphael Blanc, Francis Turjman, Mikael Mazighi, Bertrand Lapergue
    Abstract:

    OBJECTIVESeveral randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with Stent Retriever devices.METHODSThree comprehensive stroke centers prospectively collected individual data from BAO patients treated with MT. Baseline characteristics as well as radiographic and clinical outcomes were compared between the 2 MT strategies. The primary outcome measure was the rate of successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2b-3. Favorable outcome was defined as a 90-day modified Rankin Scale score of 0-2.RESULTSAmong the 100 adult patients included in the study, 46 were treated with first-line ADAPT (median age 61 years, IQR 53-71 years; Stent-Retriever rescue therapy was secondarily used in 12 [26.1%]) and 54 were treated with a primary Stent Retriever (median age 67 years, IQR 53-78 years). There was no difference in baseline characteristics between the 2 treatment groups, except for the rate of diabetes (19.6% vs 5.7%, respectively, p = 0.035). Successful reperfusion was achieved in 79% of the overall study sample. Overall, the rate of favorable outcome was 36.8% and 90-day all-cause mortality was 44.2%. Successful reperfusion positively impacted favorable outcome (OR 4.57, 95% CI 1.24-16.87, p = 0.023). A nonsignificant trend toward a higher successful reperfusion rate (unadjusted OR 2.56, 95% CI 0.90-7.29, p = 0.071) and a significantly higher rate of complete reperfusion (mTICI grade 3; unadjusted OR 2.59, 95% CI 1.14-5.86, p = 0.021) was found in the ADAPT group. The procedure duration was also significantly lower in the ADAPT group (median 45 minutes, IQR 34 to 62 minutes vs 56 minutes, IQR 40 to 90 minutes; p = 0.05), as was the rate of periprocedural complications (4.3% vs 25.9%, p = 0.003). Symptomatic intracranial hemorrhage (0.0% vs 4.0%, p = 0.51) and 90-day all-cause mortality (46.7% vs 42.0%, p = 0.65) were similar in the 2 groups.CONCLUSIONSAmong BAO patients, successful reperfusion is a strong predictor of a 90-day favorable outcome, and the choice of ADAPT as the first-line strategy achieves a significantly higher rate of complete reperfusion with a shorter procedure duration.

  • Similar Outcomes for Contact Aspiration and Stent Retriever Use According to the Admission Clot Burden Score in ASTER
    Stroke, 2018
    Co-Authors: François Zhu, Julien Labreuche, Raphael Blanc, Bertrand Lapergue, Alain Duhamel, Gautier Marnat, Suzana Saleme, Maeva Kyheng, Malek Ben Machaa, Vincent Costalat
    Abstract:

    BACKGROUND AND PURPOSE: The clot burden score (CBS) at admission reliably evaluates the thrombus burden in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy has been diversified, especially with contact aspiration technique, and its efficiency with respect to the thrombus burden is not known. We compared reperfusion, adverse events, neurological recovery, and 90-day functional outcome of Stent Retriever use versus contact aspiration according to the admission CBS. METHODS: This is a post hoc analysis of the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) randomized trial. The primary outcome was successful reperfusion after all procedures, defined as modified Thrombolysis in Cerebral Infarction scores 2b/3. Secondary outcomes were 90-day functional outcome, assessed with the modified Rankin Scale. Safety outcomes included 90-day mortality and any intracerebral hemorrhage. RESULTS: A total of 231 randomized patients were included in this study: 114 patients had a CBS of 0 to 6 and 117 a CBS ≥7 at admission. Successful reperfusion at procedure end was achieved more frequently in patients with CBS ≥7 (88.9%) than patients with a CBS 0 to 6 (81.6%; fully adjusted risk ratio, 1.09; 95% confidence interval, 1.01-1.28). Favorable outcome (modified Rankin Scale score, 0-2) at 90 days was achieved in significantly more patients with CBS ≥7 (61.9%) than in patients with CBS 0 to 6 (41.8%; fully adjusted risk ratio, 1.19; 95% confidence interval, 1.02-1.40). No outcome differences of first-line mechanical thrombectomy strategy (aspiration versus Stent) on any angiographic or clinical outcomes were observed between the 2 groups. We also found no evidence of interaction between first-line mechanical thrombectomy strategy and CBS groups regarding safety. CONCLUSIONS: First-line mechanical thrombectomy with contact aspiration compared with Stent Retriever did not result in an increased successful reperfusion rate in acute ischemic stroke patients with large vessel occlusion of the anterior circulation according to the admission CBS. The latter, however, seems to be a reliable prognostic indicator of angiographic and clinical outcome.

  • first line use of contact aspiration for thrombectomy versus a Stent Retriever for recanalization in acute cerebral infarction the randomized aster study protocol
    International Journal of Stroke, 2018
    Co-Authors: Bertrand Lapergue, Julien Labreuche, Raphael Blanc, Suzana Saleme, Vincent Costalat, X Barreau, Jerome Berge, Arturo Consoli, Georges Rodesch, Serge Bracard
    Abstract:

    Rationale Mechanical thrombectomy with a Stent Retriever is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion. New techniques for mechanical thrombectomy, such as contact aspiration, appear promising to increase reperfusion status and improve clinical outcome. Aim We aim at ascertaining whether contact aspiration is more efficient than the Stent Retriever as a first-line endovascular procedure. Sample size estimates With a two-sided test (alpha = 5%, power = 90%) and an anticipated rate of spontaneous recanalization and catheterization failures of 15%, we estimate that a sample size of 380 patients will be necessary to detect an absolute difference of 15% in primary outcome (superiority design). Methods and design The ASTER trial is a prospective, randomized, multicenter, controlled, open-label, blinded end-point clinical trial. Patients admitted with suspected ischemic anterior circulation stroke secondary to large vessel occlusion, with onset of symptoms <6 h, will be randomly assigned to contact aspiration or Stent Retriever in a 1:1 ratio; stratified by center and prior IV thrombolysis. If the assigned treatment technique is not successful after three attempts, another technique will be applied, at the operator's discretion. Study outcomes The primary outcome will be successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3) at the end of the endovascular procedures. Secondary outcome will include successful recanalization after the assigned first-line treatment technique alone, procedural times, the need for a rescue technique, complications and modified Rankin Scale at three months. Discussion No previous head to head randomized trials have directly compared contact aspiration versus Stent Retriever reperfusion techniques. This prospective trial aims to provide further evidence of benefit of contact aspiration versus Stent Retriever techniques among patients with ischemic stroke.

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  • Similar Outcomes for Contact Aspiration and Stent Retriever Use According to the Admission Clot Burden Score in ASTER
    Stroke, 2018
    Co-Authors: François Zhu, Julien Labreuche, Raphael Blanc, Bertrand Lapergue, Alain Duhamel, Gautier Marnat, Suzana Saleme, Maeva Kyheng, Malek Ben Machaa, Vincent Costalat
    Abstract:

    BACKGROUND AND PURPOSE: The clot burden score (CBS) at admission reliably evaluates the thrombus burden in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy has been diversified, especially with contact aspiration technique, and its efficiency with respect to the thrombus burden is not known. We compared reperfusion, adverse events, neurological recovery, and 90-day functional outcome of Stent Retriever use versus contact aspiration according to the admission CBS. METHODS: This is a post hoc analysis of the ASTER (Contact Aspiration Versus Stent Retriever for Successful Revascularization) randomized trial. The primary outcome was successful reperfusion after all procedures, defined as modified Thrombolysis in Cerebral Infarction scores 2b/3. Secondary outcomes were 90-day functional outcome, assessed with the modified Rankin Scale. Safety outcomes included 90-day mortality and any intracerebral hemorrhage. RESULTS: A total of 231 randomized patients were included in this study: 114 patients had a CBS of 0 to 6 and 117 a CBS ≥7 at admission. Successful reperfusion at procedure end was achieved more frequently in patients with CBS ≥7 (88.9%) than patients with a CBS 0 to 6 (81.6%; fully adjusted risk ratio, 1.09; 95% confidence interval, 1.01-1.28). Favorable outcome (modified Rankin Scale score, 0-2) at 90 days was achieved in significantly more patients with CBS ≥7 (61.9%) than in patients with CBS 0 to 6 (41.8%; fully adjusted risk ratio, 1.19; 95% confidence interval, 1.02-1.40). No outcome differences of first-line mechanical thrombectomy strategy (aspiration versus Stent) on any angiographic or clinical outcomes were observed between the 2 groups. We also found no evidence of interaction between first-line mechanical thrombectomy strategy and CBS groups regarding safety. CONCLUSIONS: First-line mechanical thrombectomy with contact aspiration compared with Stent Retriever did not result in an increased successful reperfusion rate in acute ischemic stroke patients with large vessel occlusion of the anterior circulation according to the admission CBS. The latter, however, seems to be a reliable prognostic indicator of angiographic and clinical outcome.

  • abstract 157 contact aspiration versus Stent Retriever for large vessel occlusion in the anterior circulation within six hours of symptom onset effect of mothership versus drip and ship paradigms in the aster trial
    Stroke, 2018
    Co-Authors: Michel Piotin, Benjamin Gory, Julien Labreuche, Raphael Blanc, Alain Duhamel, Vincent Costalat, Suzana Saleme, Gauthier Marnat, S Bracard, Hubert Desal
    Abstract:

    Purpose: The ASTER trial (contact Aspiration versus Stent Retriever for revascularization in patients presenting with acute ischemic stroke and a large vessel occlusion in the anterior circulation ...

  • first line use of contact aspiration for thrombectomy versus a Stent Retriever for recanalization in acute cerebral infarction the randomized aster study protocol
    International Journal of Stroke, 2018
    Co-Authors: Bertrand Lapergue, Julien Labreuche, Raphael Blanc, Suzana Saleme, Vincent Costalat, X Barreau, Jerome Berge, Arturo Consoli, Georges Rodesch, Serge Bracard
    Abstract:

    Rationale Mechanical thrombectomy with a Stent Retriever is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion. New techniques for mechanical thrombectomy, such as contact aspiration, appear promising to increase reperfusion status and improve clinical outcome. Aim We aim at ascertaining whether contact aspiration is more efficient than the Stent Retriever as a first-line endovascular procedure. Sample size estimates With a two-sided test (alpha = 5%, power = 90%) and an anticipated rate of spontaneous recanalization and catheterization failures of 15%, we estimate that a sample size of 380 patients will be necessary to detect an absolute difference of 15% in primary outcome (superiority design). Methods and design The ASTER trial is a prospective, randomized, multicenter, controlled, open-label, blinded end-point clinical trial. Patients admitted with suspected ischemic anterior circulation stroke secondary to large vessel occlusion, with onset of symptoms <6 h, will be randomly assigned to contact aspiration or Stent Retriever in a 1:1 ratio; stratified by center and prior IV thrombolysis. If the assigned treatment technique is not successful after three attempts, another technique will be applied, at the operator's discretion. Study outcomes The primary outcome will be successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3) at the end of the endovascular procedures. Secondary outcome will include successful recanalization after the assigned first-line treatment technique alone, procedural times, the need for a rescue technique, complications and modified Rankin Scale at three months. Discussion No previous head to head randomized trials have directly compared contact aspiration versus Stent Retriever reperfusion techniques. This prospective trial aims to provide further evidence of benefit of contact aspiration versus Stent Retriever techniques among patients with ischemic stroke.

  • Susceptibility vessel sign in the aster trial: higher recanalization rate and more favourable clinical outcome after first line Stent Retriever compared to contact aspiration
    Journal of Stroke, 2018
    Co-Authors: Romain Bourcier, Benjamin Gory, Julien Labreuche, Raphael Blanc, Robert Fahed, Alain Duhamel, Mikael Mazighi, Gaultier Marnat, Suzana Saleme, Vincent Costalat
    Abstract:

    OBJECTIVE: 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* 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; PP 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.

  • Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion
    JAMA Ophthalmology, 2017
    Co-Authors: Bertrand Lapergue, Benjamin Gory, Julien Labreuche, Raphael Blanc, Alain Duhamel, Gautier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal
    Abstract:

    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.