Which Is the Best Technique for Stroke Thrombectomy?

So we still have no protocol on this. You better hope your doctor guesses correctly on your treatment. There should be zero questions on what to do. You have an EXACT DIAGNOSIS, leading to an EXACT PROTOCOL, which leads to 100% recovery. If none of that is occurring, you don't have a functioning stroke hospital.  I don't know what is is but it isn't an effective stroke hospital.

Which Is the Best Technique for Stroke Thrombectomy?

While the routine use of endovascular thrombectomy has revolutionized the treatment of large vessel occlusion ischemic stroke in recent years, a new a study is addressing whether individual approaches to the procedure have an effect on outcomes.

Preliminary results of the ASSIST registry have shown some differences in time to reperfusion and early response rate between the various approaches, but 90-day neurological outcomes looked similar with all strategies.

These interim results from the ASSIST study were presented at the International Stroke Conference (ISC), held in New Orleans and online.

The study compared three different thrombectomy techniques to remove the occluding clot: use of a classic stent retriever, direct aspiration with an aspiration catheter, or a combination approach of a stent retriever together with an aspiration catheter.

"This is a global registry study of three different approaches — all using Stryker products — as the first step in stroke thrombectomy," said David Liebeskind, MD, professor of neurology at University of California, Los Angeles, who presented the study at the ISC meeting. "We are comparing different ways of opening the plumbing based on each center's preferred technique up front."

Overall, there were some small technical differences between the approaches, he said. "For example, there was a faster degree of reperfusion with the classic stent retriever, and the combination technique took longer as it is more complicated. But in terms of neurological outcomes at 90 days, we did not see any differences across the board."

Liebeskind noted, however, that the study is not yet complete, with more data to come on use of large bore catheters, site of occlusion, and other patient factors such as the size of the stroke.

"These additional results are planned to be presented at the European Stroke Organisation Conference in May and preliminary analyses suggest that there may be some interesting findings," he told theheart.org | Medscape Cardiology.

Lead author of the study, Rishi Gupta, MD, co-director of the Neurosciences Institute at Wellstar Health System, Marietta, Georgia, explained that the study was performed to identify whether one of the several currently employed operator techniques for thrombectomy in acute stroke may deliver more effective and efficient results.

He noted that there are currently operator and institutional biases based on experience, training, and comfort as to which technique is employed. "All three techniques evaluated in this study have some levels of evidence in the literature with success rates that appear similar. ASSIST selected sites with experience using one of these three techniques as their preferred strategy. This is important because the operators were proficient with this technique."

The ASSIST registry has so far included 1300 patients undergoing thrombectomy from 71 sites across North America, Europe, and Asia.