Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Thursday, February 23, 2017

Direct Aspiration On Par with Stent Retriever for Large-Vessel Strokes

So before you are treated in the emergency room you'll have to ask your doctor what direct aspiration is. And why they chose that instead of stent retriever.

Safety and efficacy similar in randomized French trial

  • by
    Senior Associate Editor, MedPage Today
  • This article is a collaboration between MedPage Today® and:
    Medpage Today
HOUSTON -- Direct aspiration of large-vessel ischemic strokes was as safe and successful for reperfusion as stent retriever use, the ASTER trial showed.
The rate of TICI 2b/3 reperfusion was 85.4% with the direct aspiration first pass technique (ADAPT) and 83.1% with stent retriever as the first-line strategy (P=0.53), Bertrand Lapergue, MD, PhD, of Foch Hospital in Suresnes, France, and colleagues reported here at the International Stroke Conference.
All safety endpoints, including new territory embolization or infarct, arterial perforation, arterial dissection, vasospasm, and intracranial or subarachnoid hemorrhage, likewise were similar between treatment strategies.
While stent retriever use has been a real advance for these large vessel occlusions, "it's good, but we think we need to increase the rate of successful reperfusion and perfect reperfusion," Lapergue said at a press conference for the late-breaking clinical trial session.
The direct aspiration technique is reasonable as an alternative first-line strategy, concluded Ralph L. Sacco, MD, of the University of Miami, past president of the American Heart Association and president-elect of the American Academy of Neurology, who served as a discussant at the briefing.
He cautioned, though, that the trial's French population may raise issues for generalizability. Stent retriever use could plausibly be better for the intracranial atherostenosis that is a more common source of ischemic stroke in certain U.S. populations than the embolic occlusions more common in French populations, he said.
Lapergue countered that there are some data suggesting that whereas stent retriever use can destabilize plaque in the vessel, aspiration is a "very traumatic technique."
A similar U.S. trial, COMPASS, is more than two-thirds enrolled and should report results within the year to answer that issue, noted another member of the panel, Ricardo A. Hanel, MD, PhD, of the Baptist Neurological Institute in Jacksonville, Fla.
Meanwhile, though, this trial was important as the first to support the idea that as long as the vessel gets recanalized, it might not matter how you get there, Hanel said.
And if all else is equal in terms of efficacy and safety, cost may be a deciding factor in clinical use, both he and Lapergue agreed, noting that the aspiration technique is less expensive, although with more rescue therapy use.
"If the catheter is used as primary line, it might be that we have the second factor as saving a $6,000 device," Hanel said.
The ASTER trial was a prospective, multicenter, controlled open-label comparison of the two strategies with blinded outcome evaluation. Patients who met large-vessel, posterior circulation ischemic stroke criteria on imaging were randomized to either direct aspiration (n=192) or stent retriever use (n=189) first-line, with a switch to other therapy allowed after three failed attempts

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