Therapeutic effect of direct aspiration versus stent-retriever thrombectomy in patients with acute ischemic stroke due to middle cerebral artery occlusion

Abstract

Objective To compare the therapeutic effects of direct aspiration and stent-retriever thrombectomy in patients with acute ischemic stroke (AIS) due to middle cerebral artery occlusion. Methods We included 59 patients with AIS due to middle cerebral artery occlusion who underwent endovascular thrombectomy in our hospital from January 2018 to December 2021. Among them, 25 cases underwent direct aspiration for thrombectomy, and 34 cases underwent stent-retriever thrombectomy. The two groups were compared in terms of basic data, successful recanalization rate, puncture-to-recanalization time, National Institutes of Health Stroke Scale (NIHSS) score before operation, change in NIHSS score immediately after operation (△1NIHSS score), change in NIHSS score at 24 h after operation (△2NIHSS score), the rate of thrombus escape, the rate of rescue treatment, the rate of intracranial hemorrhage at 7 d after operation, the mortality rate at 7 d after operation, and the percentage of patients with good prognosis at 90 d after operation. Results The time from puncture to successful recanalization was significantly shorter in the aspiration group than in the stent retriever group (t = 5.923, P<0.05). There were no significant between-group differences in the recanalization rate, the △1NIHSS score, the △2NIHSS score, the rate of thrombus escape, the rate of rescue treatment, the rate of intracranial hemorrhage at 7 d after operation, the mortality rate at 7 d after operation, and the percentage of patients with good prognosis at 90 d after operation (P>0.05). Conclusion Both direct aspiration and stent-retriever thrombectomy have good effectiveness for the treatment of AIS due to middle cerebral artery occlusion, with similar vascular recanalization rate, neurological recovery degree, and prognosis, but direct aspiration can shorten the time from puncture to recanalization.

Keywords

• infarction, middle cerebral artery|ischemic stroke|endovascular procedures|mechanical thrombolysis|comparative effectiveness research