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Updated: Nov 28, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
First-Line Contact Aspiration vs Stent Retriever for Proximal Occlusion in Acute Ischemic Stroke: A Systemic Review
Xiangyuan Zhang1, Xiong Guo1, Yunqiang Yi1
1952 hospital of the Chinese people's liberation army ground force, Neurology department, Geermu, Qinghai Province, 816000, China.
Insights
First-line contact aspiration (ASP) may be better than stent retriever alone for acute ischemic stroke treatment. Both ASP and stent retriever with local aspiration (SRLA) showed similar effectiveness, but ASP excelled in posterior circulation strokes.
Area of Science:
- Neuroscience
- Interventional Neurology
- Stroke Medicine
Background:
- Acute ischemic stroke due to large vessel occlusion requires rapid reperfusion.
- First-line treatment strategies include contact aspiration (ASP) and stent retrievers (SR).
- Comparative effectiveness of these first-line approaches needs further elucidation.
Purpose of the Study:
- To systematically review and meta-analyze the performance of first-line contact aspiration versus stent retriever in acute ischemic stroke.
- To compare reperfusion rates, clinical outcomes, and adverse events between ASP and SR thrombectomy.
- To investigate subgroup differences, particularly in posterior circulation strokes.
Main Methods:
- Systematic literature search of Cochrane databases, MEDLINE, and EMBASE.
- Inclusion of thirteen studies with 1614 patients undergoing thrombectomy.
- Meta-analysis of outcomes including reperfusion rates, recanalization, functional outcomes, and adverse events.
Main Results:
- No significant differences in final reperfusion, complete recanalization, or favorable outcomes between SR and ASP.
- Similar rates of emboli to new territories, intracranial hemorrhage, and 90-day mortality.
- Contact aspiration showed a lower rate of symptomatic intracerebral hemorrhage.
- ASP demonstrated superiority over stent retriever alone and was comparable to stent retriever with local aspiration (SRLA).
- Contact aspiration achieved significantly higher reperfusion in posterior circulation strokes with fewer rescue therapies.
Conclusions:
- Contact aspiration may offer advantages over stent retriever alone and is potentially more suitable for posterior circulation strokes.
- ASP and SRLA thrombectomy demonstrate comparable efficacy in achieving good clinical outcomes.
- Further research is warranted to validate these findings and refine treatment guidelines.
Introduction:
The aim of this systematic review and meta-analysis was to compare the performance of first-line contact aspiration (ASP) and stent retriever (SR) in acute ischemic stroke caused by proximal large vessel occlusion.
Methods:
Cochrane databases, MEDLINE and EMBASE were systematically searched for literatures reporting outcomes on thrombectomy with both first-line aspiration and first-line stent retriever in proximal occlusion.
Results:
Thirteen studies with a total of 1614 patients were included. No differences were identified between the SR and ASP groups in terms of final reperfusion rate (modified thrombolysis in cerebral infarction 2b/3) (OR: 1.54, 95% CI: 0.88-2.70), complete recanalization rate (modified thrombolysis in cerebral infarction 3) (OR: 1.78, 95% CI: 0.58-5.44), and favorable outcomes (modified Rankin scale ≤2) (OR: 1.02, 95% CI: 0.79-1.32). With regard to adverse events, emboli to new territories (OR: 0.81, 95% CI: 0.31-2.14), intracranial hemorrhage (OR: 0.71, 95% CI: 0.40-1.28), 90-days mortality (OR: 1.02, 95% CI: 0.71-1.47) were similar between groups, while symptomatic intracerebral hemorrhage (OR: 0.43 95% CI: 0.21-0.86) was less seen in ASP. Subgroup analysis indicated that ASP was comparable to stent retriever with local aspiration (SRLA) (OR: 1.25 95% CI: 0.25-6.22) and superior to stent retriever alone (OR: 1.85 95% CI: 1.22-2.81). Moreover, in posterior circulation, contact aspiration achieved a significantly higher reperfusion (OR: 1.97 95% CI: 1.03-3.76) compared to stent retriever, and needed relatively less rescue therapies (21.5% vs 29.6%, p < 0.05).
Conclusion:
Our study suggested that contact aspiration might be advantageous over stent retriever alone and more suitable in posterior circulation. While ASP and SRLA thrombectomy were equally effective in achieving good clinical outcomes. However, further studies are needed to confirm these results.
