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Frontline aspiration versus stent retriever thrombectomy for M2 occlusions: Insights from the STAR registry

Michael Gaub1, Rahim Abo Kasem2, Ilko Maier3

  • 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.

European Stroke Journal
|January 30, 2026
PubMed
Abstract

Insights

Frontline aspiration for medium vessel occlusions (MeVO) demonstrated superior functional independence and recanalization rates compared to stent retrievers (SR). This approach also led to shorter procedure times and reduced symptomatic intracranial hemorrhage, suggesting a potential advancement in stroke treatment.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Neurosurgery

Background:

  • Endovascular treatment uncertainty for medium vessel occlusions (MeVO).
  • Stent retrievers (SR) were primary in recent trials.
  • Need to compare frontline aspiration versus SR for M2 occlusions.

Purpose of the Study:

  • Compare outcomes of frontline aspiration versus stent retrievers (SR) for acute M2 occlusions.
  • Identify factors influencing treatment effectiveness.

Main Methods:

  • Retrospective analysis of a multicenter stroke thrombectomy cohort.
  • Propensity score-matched (PSM) analysis comparing frontline aspiration to SR.
  • Primary outcome: functional independence (mRS 0-2) at 90 days.

Main Results:

  • Frontline aspiration favored functional independence (49.9% vs 44.0%) and complete recanalization (61.2% vs 48.7%) in PSM analysis.
  • Aspiration showed a significantly lower rate of symptomatic intracranial hemorrhage (sICH) (3.5% vs 6.2%).
  • Frontline aspiration resulted in significantly shorter procedural times (28 vs 51 minutes).

Conclusions:

  • Frontline aspiration for M2 occlusions yields superior clinical and angiographic outcomes over SR.
  • Contact aspiration thrombectomy warrants further investigation for MeVO treatment.
Keywords:
Mechanical thrombectomyaspirationmiddle cerebral arterystent retrievers

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