Aspiration Versus Stent Retriever Thrombectomy for Posterior Circulation Stroke

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Endovascular treatment efficacy is established for anterior circulation stroke, but not for posterior circulation.
• Advanced thrombectomy devices are crucial for anterior circulation stroke benefit.
• Limited knowledge exists on thrombectomy techniques' impact on posterior circulation stroke outcomes.

Purpose of the Study:

• To compare first-line direct aspiration versus stent retriever thrombectomy for posterior circulation stroke.
• To evaluate the impact of thrombectomy technique on functional outcome, reperfusion, and procedure duration.

Main Methods:

• Retrospective analysis of 205 patients from a nationwide registry (March 2014-December 2018).
• Comparison of first-line aspiration versus stent retriever thrombectomy in posterior circulation stroke.
• Multivariable ordinal logistic regression used to analyze associations between thrombectomy technique and outcomes.

Main Results:

• First-line aspiration (71 patients) was associated with better functional outcomes (aOR 1.94) compared to stent retriever thrombectomy (134 patients).
• Successful reperfusion (TICI ≥2B) was higher with aspiration (87%) versus stent retriever (73%).
• Aspiration group had shorter procedure times (49 min vs. 69 min) and comparable symptomatic hemorrhage rates.

Conclusions:

• First-line aspiration thrombectomy appears superior to stent retriever thrombectomy for large vessel occlusion in posterior circulation stroke.
• Aspiration is linked to shorter procedure times, enhanced reperfusion, and improved clinical outcomes.
• Findings suggest aspiration as a potentially more effective first-line strategy for posterior circulation stroke.