Combined stent retriever and contact aspiration improves first-line recanalisation but not clinical outcomes: a pooled analysis of the ASTER, ASTER2, and VECTOR trials
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.
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BibTeX
@article{marnat2026combined,
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}},
author = {Gaultier Marnat and Bertrand Lapergue and Michel Piotin and Julien Labreuche and Cyril Dargazanli and Hubert Desal and Benjamin Gory and François Zhu and Aymeric Rouchaud and Arturo Consoli and Eimad Shotar and Jildaz Caroff and François Eugene and Jean-Philippe Desilles and Kevin Janot and Gregoire Boulouis and Jean-Christophe Gentric and Vincent L’allinec and Frédéric Clarençon and Basile Kerleroux and Raoul Pop and Sébastien Soize and Mikael Mazighi and Frédéric Bourdain and Sebastian Richter and Emmanuel Houdart and Nicolas Bricout and Xavier Barreau and Raphael Blanc and Romain Bourcier},
journal = {European Stroke Journal},
year = {2026},
month = jul,
doi = {10.1093/esj/aakag077},
url = {https://hal.science/hal-05751620v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Combined stent retriever and contact aspiration improves first-line recanalisation but not clinical outcomes: a pooled analysis of the ASTER, ASTER2, and VECTOR trials
AU - Gaultier Marnat
AU - Bertrand Lapergue
AU - Michel Piotin
AU - Julien Labreuche
AU - Cyril Dargazanli
AU - Hubert Desal
AU - Benjamin Gory
AU - François Zhu
AU - Aymeric Rouchaud
AU - Arturo Consoli
AU - Eimad Shotar
AU - Jildaz Caroff
AU - François Eugene
AU - Jean-Philippe Desilles
AU - Kevin Janot
AU - Gregoire Boulouis
AU - Jean-Christophe Gentric
AU - Vincent L’allinec
AU - Frédéric Clarençon
AU - Basile Kerleroux
AU - Raoul Pop
AU - Sébastien Soize
AU - Mikael Mazighi
AU - Frédéric Bourdain
AU - Sebastian Richter
AU - Emmanuel Houdart
AU - Nicolas Bricout
AU - Xavier Barreau
AU - Raphael Blanc
AU - Romain Bourcier
PY - 2026
DA - 2026/07/06
JO - European Stroke Journal
DO - 10.1093/esj/aakag077
UR - https://hal.science/hal-05751620v1
AB - 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.
SN - 2396-9873
SN - 2396-9881
ER -