{
  "abstract": "Introduction The best first-line mechanical thrombectomy treatment for acute ischemic stroke (AIS) caused by anterior large vessel occlusion (LVO) remains unclear despite four randomised controlled trials (RCTs). We compared the effectiveness and safety of the first-line combined stent retriever (SR) + contact aspiration (CA) approach with SR or CA alone for the treatment of AIS due to LVO. Patients and Methods This retrospective analysis combines individual patient data from 3 large multicenter, RCTs: ASTER, ASTER2, and VECTOR. The primary outcome was the proportion of patients who achieved favourable recanalisation (defined as a modified Thrombolysis in Cerebral Infarction score of 2b, 2c or 3) after the first-line treatment, without a second-line rescue technique. Secondary outcomes included the first pass effect, disability assessed by the 90-day modified Rankin Scale (mRS) score, 24-hour change in National Institutes of Health Stroke Scale (NIHSS), 90-day all-cause mortality, and serious procedure-related adverse events. Results Among 1,185 included patients, 434 received the combined approach, 414 received CA alone, and 337 received SR alone. Baseline characteristics were similar among groups. After adjusting for factors using propensity score weighting, the primary outcome was achieved more often in the combined group compared to CA alone (risk ratio = 1.95; 95% CI, 1.42 to 2.68; P < 0.001) or SR alone (Odds ratio = 1.70; 95% CI, 1.21 to 2.38; P = .002). There were no significant differences in 24-hour change in NIHSS, 90-day mRS, or adverse events among the groups. Conclusions In this pooled analysis of 3 RCTs, the combined approach as the first-line treatment for anterior circulation LVO increased the probability of achieving favourable recanalisation without the need for a second-line approach, compared to CA or SR alone but no impact on clinical outcomes was detected.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 30,
  "authors": [
    {
      "name": "Gaultier Marnat"
    },
    {
      "name": "Bertrand Lapergue"
    },
    {
      "name": "Michel Piotin"
    },
    {
      "name": "Julien Labreuche"
    },
    {
      "name": "Cyril Dargazanli"
    },
    {
      "name": "Hubert Desal"
    },
    {
      "name": "Benjamin Gory"
    },
    {
      "name": "François Zhu"
    },
    {
      "name": "Aymeric Rouchaud"
    },
    {
      "name": "Arturo Consoli"
    },
    {
      "name": "Eimad Shotar"
    },
    {
      "name": "Jildaz Caroff"
    },
    {
      "name": "François Eugene"
    },
    {
      "name": "Jean-Philippe Desilles"
    },
    {
      "name": "Kevin Janot"
    },
    {
      "name": "Gregoire Boulouis"
    },
    {
      "name": "Jean-Christophe Gentric"
    },
    {
      "name": "Vincent L’allinec"
    },
    {
      "name": "Frédéric Clarençon"
    },
    {
      "name": "Basile Kerleroux"
    },
    {
      "name": "Raoul Pop"
    },
    {
      "name": "Sébastien Soize"
    },
    {
      "name": "Mikael Mazighi"
    },
    {
      "name": "Frédéric Bourdain"
    },
    {
      "name": "Sebastian Richter"
    },
    {
      "name": "Emmanuel Houdart"
    },
    {
      "name": "Nicolas Bricout"
    },
    {
      "name": "Xavier Barreau"
    },
    {
      "name": "Raphael Blanc"
    },
    {
      "name": "Romain Bourcier"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ab74pwbnsw0b8.bib",
  "cited_by": 0,
  "doi": "10.1093/esj/aakag077",
  "fulltext_url": null,
  "id": "ab74pwbnsw0b8",
  "issns": [
    "2396-9873",
    "2396-9881"
  ],
  "landing_url": "https://hal.science/hal-05751620v1",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.neu"
    ],
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7167480161",
  "pdf_url": "https://hal.science/hal-05751620/document",
  "pmcid": null,
  "pmid": "42406908",
  "published": "2026-07-06",
  "publisher": "Sage Publications",
  "ris": "https://research.draconitic.com/paper/ab74pwbnsw0b8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:59Z",
      "native_id": "hal-05751620",
      "source": "hal",
      "url": "https://hal.science/hal-05751620v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "hal:1.sdv.neu",
      "subfield": "neuroscience"
    }
  ],
  "title": "Combined stent retriever and contact aspiration improves first-line recanalisation but not clinical outcomes: a pooled analysis of the ASTER, ASTER2, and VECTOR trials",
  "title_text": "Combined stent retriever and contact aspiration improves first-line recanalisation but not clinical outcomes: a pooled analysis of the ASTER, ASTER2, and VECTOR trials",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:59Z",
  "url": "https://research.draconitic.com/paper/ab74pwbnsw0b8",
  "venue": "European Stroke Journal",
  "versions": []
}