Related Experiment Video
Updated: Dec 28, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comparison of Aspiration versus Stent Retriever Thrombectomy as the Preferred Strategy for Patients with Acute
1From the Department of Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
Insights
Aspiration thrombectomy is superior to stent retriever thrombectomy for treating terminal internal carotid artery (ICA) occlusion, achieving better reperfusion rates and fewer complications. This endovascular approach offers a safer and more effective treatment option for patients with ICA occlusion.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Endovascular treatment for terminal internal carotid artery (ICA) occlusion lacks a consensus approach.
- Evaluating the comparative safety and efficacy of different thrombectomy techniques is crucial.
Purpose of the Study:
- To compare aspiration thrombectomy versus stent retriever thrombectomy for revascularization in isolated terminal ICA occlusion.
- To assess the safety and efficacy of these endovascular strategies.
Main Methods:
- Retrospective analysis of 109 patients with terminal ICA occlusion from 2013-2018.
- Propensity score matching to minimize bias, comparing aspiration thrombectomy (30 patients) with stent retriever thrombectomy (30 patients).
- Primary outcomes included successful reperfusion (expanded TICI 2b-3) and puncture-to-reperfusion time.
Main Results:
- Aspiration thrombectomy showed a significantly higher rate of complete reperfusion (OR 4.75; P = .002).
- The median puncture-to-reperfusion time was shorter with aspiration thrombectomy (38 vs. 69 minutes; P = .001).
- Fewer intracerebral hemorrhage events occurred in the aspiration thrombectomy group (OR 0.29; P = .028).
Conclusions:
- Aspiration thrombectomy is technically superior to stent retriever thrombectomy for terminal ICA occlusion when a balloon guide catheter is not used.
- This technique achieves successful reperfusion more effectively with reduced procedure-related adverse events.
Background And Purpose:
There is no consensus on endovascular treatment for terminal ICA. The purpose of this study was to evaluate the comparative safety and efficacy of preferred aspiration thrombectomy and stent retriever thrombectomy for revascularization in patients with isolated terminal ICA occlusion.
Materials And Methods:
We conducted a retrospective analysis of patients with terminal ICA occlusion treated with aspiration thrombectomy or stent retriever thrombectomy in our center, from September 2013 to November 2018. To minimize the case bias, propensity score matching was performed. The primary outcomes were successful reperfusion defined by expanded TICI grades 2b-3 at the end of all endovascular procedures and puncture-to-reperfusion time.
Results:
A total of 109 consecutive patients with terminal ICA occlusion were divided into the aspiration thrombectomy group (40 patients) and the stent retriever thrombectomy group (69 patients), and 30 patients were included in each group after propensity score matching. The proportion of complete reperfusion was significantly higher in the aspiration thrombectomy group (OR 4.75 [95% CI, 1.10-1.38]; P = .002). The median puncture-to-reperfusion time in the aspiration thrombectomy group was shorter than that in the stent retriever thrombectomy group (38 versus 69 minutes; P = .001). Fewer intracerebral hemorrhage events were recorded in the aspiration thrombectomy group (OR 0.29 [95% CI, 0.09-0.90]; P = .028). No significant differences were observed for good outcomes (OR 1.92 [95% CI, 0.86-4.25]) and mortality (OR 0.84 [95% CI, 0.29-2.44]) at 90 days.
Conclusions:
For the treatment of terminal ICA occlusion, aspiration thrombectomy was technically superior to stent retriever thrombectomy in the absence of a balloon guide catheter in achieving successful reperfusion with shorter puncture-to-reperfusion time and procedure-related adverse events.
