{
  "abstract": "Introduction The optimal thrombectomy technique for medium/distal vessel occlusions (MDVOs) remains uncertain.Objective To compare the safety and efficacy of aspiration thrombectomy (ADAPT) versus stent retriever thrombectomy (SR only) versus a primary combined approach (PCA).Patients and methods In this post hoc analysis of the DISTAL Trial, patients treated with first-line ADAPT, SR only, or PCA were included. The primary outcome was successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3). Secondary outcomes included functional outcome (modified Rankin Scale score at 90 days) and intracranial hemorrhage. Statistical analysis was performed using mixed-effects logistic regression models.Results Of 222 patients treated with thrombectomy, 36 underwent ADAPT, 37 SR only, and 149 a PCA as first-line strategy. The median number of thrombectomy passes was 1 (IQR 1–2). Final successful reperfusion was achieved in 76.5% with first-line ADAPT, in 61.1% with first-line SR only, and in 82.4% with first-line PCA. First pass successful reperfusion was achieved in 44.4% with ADAPT, 59.5% with SR only, and 66.4% with PCA. PCA was associated with higher first pass reperfusion rates compared with ADAPT (aOR=2.37, 95% CI 1.13 to 5.05, P=0.024). There were no significant differences in functional outcomes or safety endpoints among the techniques. ADAPT resulted in numerically more favorable functional outcome. PCA resulted in numerically higher numbers of symptomatic intracranial hemorrhage.Discussion and conclusion Final successful reperfusion rate after PCA was higher than after SR only. Functional and safety outcomes were not significantly different. Further research is warranted, including individual patient data meta-analyses and data on novel aspiration devices not used in this trial.",
  "authors": [
    {
      "affiliations": [
        "Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Victor Schulze-Zachau"
    },
    {
      "affiliations": [
        "Clinical Research Department, Universitätsspital Basel, Basel, Switzerland"
      ],
      "name": "Nikki Rommers"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland"
      ],
      "name": "Tomas Dobrocky"
    },
    {
      "affiliations": [
        "Department of Interventional and Diagnostic Neuroradiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland"
      ],
      "name": "Steven D Hajdu"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany"
      ],
      "name": "Jens Fiehler"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal"
      ],
      "name": "Isabel Fragata"
    },
    {
      "affiliations": [
        "Department for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland"
      ],
      "name": "Jan Gralla"
    },
    {
      "affiliations": [
        "Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland"
      ],
      "name": "Paolo Machi"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Klinikum rechts der Isar, Munich, Germany, Germany"
      ],
      "name": "Jan S Kirschke"
    },
    {
      "affiliations": [
        "Department of Radiology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands"
      ],
      "name": "Adriaan C G.M van Es"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital Bern, Bern, Switzerland"
      ],
      "name": "Johannes Kaesmacher"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Asklepios Hospital St. Georg, Hamburg, Germany"
      ],
      "name": "Jan-Hendrik Buhk"
    },
    {
      "affiliations": [
        "Department of Neurology, UCLA, Los Angeles, California, USA",
        "Comprehensive Stroke Center and Neurology, David Geffen School of Medicine, Los Angeles, California, USA"
      ],
      "name": "Jeffrey L Saver"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain",
        "Department of Interventional Neuroradiology.Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain"
      ],
      "name": "Mario Martínez-Galdámez"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Inselspital - Bern University Hospital, Switzerland, Bern, Switzerland"
      ],
      "name": "Eike Immo I Piechowiak"
    },
    {
      "affiliations": [
        "University Hospital Carl Gustav Carus, Dresden, Germany",
        "Technical University Dresden, Dresden, Germany"
      ],
      "name": "Daniel P O Kaiser"
    },
    {
      "affiliations": [
        "Department of Interventional Radiology, Hôpital Civil Marie Curie, Brussel, Belgium"
      ],
      "name": "Illario Tancredi"
    },
    {
      "affiliations": [
        "Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium"
      ],
      "name": "Frans Van Den Bergh"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Section, HOCH Health Ostschweiz, St. Gallen, Switzerland"
      ],
      "name": "Victoria Hellstern"
    },
    {
      "affiliations": [
        "Klinikum Stuttgart, Stuttgart, Germany"
      ],
      "name": "Ali Khanafer"
    },
    {
      "affiliations": [
        "Department of Radiology, Dalhousie University, Halifax, Nova Scotia, Canada"
      ],
      "name": "David Volders"
    },
    {
      "affiliations": [
        "Univ Helsinki, Helsinki, Finland"
      ],
      "name": "Daniel Strbian"
    },
    {
      "affiliations": [
        "Stroke Unit. Neurology, Hospital Vall d’Hebron, Barcelona, Spain",
        "Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain"
      ],
      "name": "Marc Ribo"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital Zentrumsspital, Luzern, Switzerland"
      ],
      "name": "Grzegorz Marek Karwacki"
    },
    {
      "affiliations": [
        "Department of Diagnostic & Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Vera Aebischer"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Alex Brehm"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Bern, Bern, Switzerland"
      ],
      "name": "Urs Fischer"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Marios-Nikos Psychogios"
    },
    {
      "affiliations": [
        "University Hospital Basel, Basel, BS, Switzerland"
      ],
      "name": "DISTAL Collaborators"
    }
  ],
  "title": "Impact of thrombectomy techniques on outcome in medium or distal vessel occlusion: subanalysis of the DISTAL Trial",
  "uid": "e5d019d9-e9bd-5bc1-98da-8bc29ba8eacc"
}