Abstract WP17: Stent Retriever versus Aspiration Thrombectomy for Distal Occlusions in Acute Stroke - Insights From the STAR Collaboration

Abstract

Introduction: Aspiration thrombectomy using the ADAPT technique has been shown to have similar efficacy to stent retriever thrombectomy (SRT) in randomized trials of proximal large vessel occlusions. In this work, we investigated the differences in technical and clinical outcomes between ADAPT and SRT for distal vessel occlusions from the Stroke Thrombectomy and Aneurysm Registry (STAR). Methods: Patients undergoing thrombectomy for acute ischemic stroke at 12 comprehensive stroke centers in the US and Europe between 01/2013 and 12/2018 were reviewed. Data was collected retrospectively from patient charts, procedure notes, and patient follow-up in neurology clinics for patients with isolated distal artery occlusion including MCA2, MCA3/4, ACA1/2, and PCA2/3. Clinical endpoint was the modified Rankin score (mRS) at 90-days, and technical outcomes were procedure time, total attempts, and mTICI scores. Results: A total of 464 patients (mean age 69±13.5 years) were treated with ADAPT (56%) or SRT (44%) for distal occlusions during the study period. Patients in the ADPAT group were mainly treated using 3MAX (36%), 4MAX (21%), ACE68/64 (20%), 5MAX/ACE (12%). SRT group included the use of Trevo (50%), Solitaire (44%), or both (5%). There were no significant differences in rates of good outcomes or successful recanalization between ADAPT and SRT groups on multivariate logistic regression analysis controlling for significant confounding variables (p>0.1). Use of SRT in distal occlusions was an independent predictor of longer procedure times compared to ADAPT on linear regression (coefficient=23, p<0.001), and there was a trend toward higher odds of symptomatic hemorrhage in the SRT group (OR=2.6, p=0.06) on multivariate analysis. There were no differences in mortality and complication rates between the two groups. Conclusions: Both SRT and ADAPT thrombectomy lead to comparable rates of favorable outcome for distal vessel occlusion. SRT requires longer procedures and may be associated with higher rates of hemorrhage. Further randomized trials are needed to confirm whether either techniques may provide a better safety or efficacy profile in distal vessel occlusions.