Aspiration Thrombectomy Versus Stent-Retriever Thrombectomy for the First-Pass Therapy of Intracranial Atherosclerosis–Related Large Vessel Occlusion: A Post Hoc Analysis of The Endovascular Treatment With Versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke Trial

Abstract

BackgroundThis study sought to scrutinize the clinical outcomes associated with first-pass mechanical thrombectomy (MT) strategies in the management of intracranial atherosclerosis (ICAS)-related large vessel occlusion (LVO). MethodsWithin this post-hoc analysis of the RESCUE BT trial, we compared data pertaining to ICAS-LVO patients situated in the anterior circulation who underwent initial therapeutic interventions utilising either aspiration thrombectomy or stent-retriever thrombectomy. The analysis encompassed the assessment of intraprocedural recanalization, rescue procedures involving balloon angioplasty or stenting, 48-hour reocclusion rates, occurrences of cerebral hemorrhagic complications, and 90-day Modified Rankin Scale (mRS) scores. ResultsAmong the 948 patients encompassed in the RESCUE BT trial, a total of 230 patients with ICAS-LVO in the anterior circulation were enrolled in the study. Of these, 111 underwent aspiration thrombectomy as the first-pass therapy, while 119 patients underwent stent-retriever thrombectomy as the initial intervention. The difference in first pass recanalization rates between aspiration thrombectomy and stent-retriever thrombectomy was not statistically significant (17.1% vs. 14.3%, p=0.555), and mechanical thrombectomy success rates (90.1% vs. 90.8%, p=0.864), the use of balloon angioplasty or stenting for rescue therapy (54.6% vs. 45.9%, p=0.189; 23.4% vs. 25.2%, p=0.752), and favorable 90-day mRS outcomes (53.2% vs. 40.3%, p=0.051) showed no statistically significant differences. ConclusionsBoth aspiration thrombectomy and stent-retriever thrombectomy can be considered as primary therapeutic options for patients presenting with ICAS-LVO in the anterior circulation.