Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion:data from ANGEL-ACT registry

Background and purpose An analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion(LVO)stroke between stent retrieval(SR)alone as a first-line mechanical thrombectomy(MT)technique(SR alone first-line)and concomitant use of contact aspiration(CA)plus SR as a first-line MT technique(SR+CA first-line).The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.Methods We conducted the present study by using the data from the ANGEL-ACT registry.We divided the selected patients into SR+CA first-line and SR alone first-line groups.We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes,including successful/complete recanalisation after the first technique alone and all procedures,first-pass successful/complete recanalisation,number of passes,90-day modified Rankin Scale,procedure duration,rescue treatment and intracranial haemorrhage within 24 hours.Results Of the 1233 enrolled patients,1069(86.7%)received SR alone first-line,and 164(13.3%)received SR+CA first-line.SR+CA first-line was associated with more thrombectomy passes(3(2-4)vs 2(1-2);β=1.77,95%CI=1.55 to 1.99,p<0.001),and longer procedure duration(86(60-129)min vs 80(50-122)min;β=10.76,95%CI=1.08 to 20.43,p=0.029)than SR alone first-line group.Other outcomes were comparable(all p>0.05)between the two groups.Conclusions Patients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line.Additionally,we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level,first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.