Bertrand Lapergue , Julien Labreuche , Raphaël Blanc , Gaultier Marnat , Arturo Consoli , Georges Rodesch , Suzanna Saleme , Vincent Costalat , Serge Bracard , Hubert Desal , Alain Duhamel , Mikael Mazighi , Laurent Spelle , Emmanuel Houdart , Eimad Shotar , Malek Ben Maacha , Delphine Lopez , Jean-Christophe Ferre , Claire Prevot , Benjamin Gory , Michel Piotin
April 15 2020
January 08 2020
Mechanical thrombectomy (MT) using a stent retriever (SR) device is currently the recommended treatment in ischemic stroke due to anterior circulation large vessel occlusion. Combining contact aspiration (CA) with SR is a promising new treatment, although it was not found to be superior to SR alone as first-line treatment for achieving successful reperfusion.
To determine whether endovascular treatment combining first-line use of CA and SR is more efficient than SR alone.
The ASTER 2 clinical trial is a prospective, randomized, multicenter, open-label trial with a blinded endpoint. We included patients admitted with suspected anterior circulation ischemic stroke secondary to large vessel occlusion <8 hours from symptom onset. They were randomly allocated in a 1:1 ratio to one of two treatment groups (combined CA and SR or SR alone). In the case of failure of the assigned technique after three attempts, other adjunctive techniques were applied.
The primary outcome is the rate of successful/complete reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score 2c/3) after the entire endovascular procedure. Secondary outcomes include reperfusion rates after the assigned first-line intervention alone and at the end of the procedure, procedural times, change in NIH Stroke Scale score at 24 hours, intracerebral hemorrhage at 24 hours, procedure-related serious adverse events, the modified Rankin Scale score, and all-cause mortality at 90 days and 1 year. The cost effectiveness of the two procedures will also be analyzed.