Stroke: Posterior circulation ischemia, direct aspiration vs. stent removal, which is better?

Endovascular therapy (EVT) has been shown to be very effective for anterior circulation strokes .
Recent trials testing the efficacy of EVT for posterior circulation strokes have not shown significant benefits.
The reason for this difference in therapeutic effect is not clear.
The difference between anterior circulation and posterior circulation Vascular anatomy differences may play a role
.
The presence of a large number of small perforated arterial branches supplying the brainstem by the basilar artery may affect the effect of endovascular treatment

The stent recovery device is the most commonly used equipment in the pre-cycle test
.
The stent is thrombosis self-expanding stent deployment, thrombus pushed to the side, and which is wound around the stent struts

In addition, during the stent removal process, the vessel wall may be damaged by the stent struts
.
Another treatment method, suction, uses suction to grab and remove blood clots

Compared with the stent retriever, the risk of manipulating the thrombus to occlude small perforated vessels appears to be lower
.
At the same time, compared with the stent retriever, the traction force on the blood vessel is smaller when the bleeding thrombus is drawn with the suction catheter, which reduces the risk of endothelial injury

In this way, Marie Louise E.
Bernse of Rijnstate ziekenhuis Arnhem, the Netherlands, and others used MR CLEAN registry data to compare the clinical outcomes, reperfusion levels, and reperfusion levels of first-line direct aspiration and first-line stent removal strategies in patients with ischemic stroke in the posterior circulation.
EVT operation time and complication rate
.

They analyzed the data of patients with posterior circulation stroke included in the Dutch multi-center randomized clinical trial registry for endovascular treatment of acute ischemic stroke between March 2014 and December 2018.
This is a prospective national study in which Collected data on consecutive patients receiving endovascular treatment for ischemic stroke in the Netherlands
.
They compared patients who underwent first-line aspiration with stent thrombectomy

In total, 71 of the 205 patients (35%) were treated with aspiration, and 134 (65%) were treated with stent retractor thrombectomy
.
Patients in the aspiration group had lower pc-ASPECTS on baseline computed tomography scans, and patients in this group received general anesthesia more often

Compared with stent retractor thrombectomy, first-line aspiration is associated with a better functional prognosis (the adjusted modified Rankin scale has a common probability of 1.
94 [95%CI, 1.
03-3.
65] to improve by 1 point)
.
Successful reperfusion (expanded cerebral infarction thrombolytic therapy ≥ 2B) is more achieved by suction (87% vs.

In this retrospective non-randomized cohort study, the results of the study showed that in patients with ischemic stroke with posterior circulation and great vessel occlusion, first-line aspiration has shorter operation time and better reperfusion effect than stent retractor thrombectomy.
Good, the clinical effect is better
.