Combined stent retriever and contact aspiration improves first-line recanalisation but not clinical outcomes: a pooled analysis of the ASTER, ASTER2, and VECTOR trials
Year: 2026
Type: article
Abstract: INTRODUCTION: The best first-line mechanical thrombectomy treatment for acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) remains unclear despite four randomised controlled trials (RCTs). We compared the effectiveness and safety of the first-line combined stent retriever (SR) + contact aspiration (CA) approach with SR or CA alone for the treatment of AIS due to LVO. PATIENTS AND METHODS: This retrospective analysis combines individual patient data from 3 large multicenter, RCTs: ASTER, ASTER2, and VECTOR. The primary outcome was the proportion of patients who achieved favourable recanalisation (defined as a modified Thrombolysis in Cerebral Infarction score of 2b, 2c or 3) after the first-line treatment, without a second-line rescue technique. Secondary outcomes included the first pass effect, disability assessed by the 90-day modified Rankin Scale (mRS) score, 24-hour change in National Institutes of Health Stroke Scale (NIHSS), 90-day all-cause mortality, and serious procedure-related adverse events. RESULTS: Among 1,185 included patients, 434 received the combined approach, 414 received CA alone, and 337 received SR alone. Baseline characteristics were similar among groups. After adjusting for factors using propensity score weighting, the primary outcome was achieved more often in the combined group compared to CA alone (risk ratio = 1.95; 95% CI, 1.42 to 2.68; P < 0.001) or SR alone (Odds ratio = 1.70; 95% CI, 1.21 to 2.38; P = .002). There were no significant differences in 24-hour change in NIHSS, 90-day mRS, or adverse events among the groups. CONCLUSIONS: In this pooled analysis of 3 RCTs, the combined approach as the first-line treatment for anterior circulation LVO increased the probability of achieving favourable recanalisation without the need for a second-line approach, compared to CA or SR alone but no impact on clinical outcomes was detected.
Source: European Stroke Journal
DOI: 10.1093/esj/aakag077
Authors: Gaultier Marnat, Bertrand Lapergue, Michel Piotin, Julien Labreuche, Cyril Dargazanli, Hubert Desal, Benjamin Gory, François Zhu, Aymeric Rouchaud, Arturo Consoli, Eimad Shotar, Jildaz Caroff, François Eugene, Jean-Philippe Desilles, Kevin Janot, Gregoire Boulouis, Jean-Christophe Gentric, Vincent L’Allinec, Frédéric Clarençon, Basile Kerleroux, Raoul Pop, Sébastien Soize, Mikael Mazighi, Frédéric Bourdain, Sebastian Richter, Emmanuel Houdart, Nicolas Bricout, Xavier Barreau, Raphael Blanc, Romain Bourcier
Institutions: Centre Hospitalier Universitaire de Bordeaux, Hôpital Foch, Hôpital Rothschild, Fondation de Rothschild, Centre Hospitalier Universitaire de Lille, Centre Hospitalier Universitaire de Montpellier, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Régional et Universitaire de Nancy, Centre Hospitalier Universitaire de Limoges, Pitié-Salpêtrière Hospital, Bicêtre Hospital, Centre Hospitalier Universitaire de Rennes, Centre Hospitalier Universitaire de Tours, Université de Tours, Inserm, Imaging, Brain, and Neuropsychiatry, Centre Hospitalier Régional Universitaire de Brest, Centre Hospitalier Universitaire d'Angers, Assistance Publique Hôpitaux de Marseille, Hôpitaux Universitaires de Strasbourg, Centre Hospitalier Universitaire de Reims, Institut Universitaire de France, Université Paris Cité, Hôpital Lariboisière, FHU Neurovasc, Optimisation Thérapeutique en Neuropsychopharmacologie, Centre Hospitalier de la Côte Basque, Centre National de la Recherche Scientifique, Institut du Thorax, Nantes Université
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7167480161