Evidence map›Paper›PMID 41614461›Full record

ArticleEuropean stroke journal2026

Frontline aspiration versus stent retriever thrombectomy for M2 occlusions: Insights from the STAR registry.

Michael Gaub, Rahim Abo Kasem, Ilko Maier, Ansaar Rai, Pascal Jabbour, Joon-Tae Kim, Brian Howard, Ali Alawieh, Stacey Quintero Wolfe, Robert M Starke and 37 more

Abstract readMulticenter StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

47 authors.

Michael GaubDepartment of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.ORCID 0009-0004-7977-8532
Rahim Abo KasemDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.ORCID 0000-0002-9635-7471
Ilko MaierDepartment of Neurology, University Medicine Goettingen, Goettingen, Germany.ORCID 0000-0001-6988-8878
Ansaar RaiDepartment of Neuroradiology, West Virginia University, Morgantown, WV, USA.
Pascal JabbourDepartment of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.ORCID 0000-0002-8965-2413
Joon-Tae KimDepartment of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
Brian HowardDepartment of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Ali AlawiehDepartment of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Stacey Quintero WolfeDepartment of Neurosurgery, Wake Forest School of Medicine, Winston Salem, NC, USA.
Robert M StarkeDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Marios-Nikos PsychogiosDepartment of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Amir ShabanDepartment of Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA.
Nitin GoyalDepartment of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA.
Justin DyeDepartment of Neurosurgery, Loma Linda University Health, Loma Linda, CA, USA.
Ali AlarajDepartment of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
Mohamad EzzeldinDepartment of Clinical Sciences, College of Medicine, University of Houston, Houston, TX, USA.
Shinichi YoshimuraDepartment of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
David FiorellaDepartment of Neurosurgery, The State University of New York at Stony Brook (SUNY SB), New York, NY, USA.
Omar TanweerDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Daniele G RomanoDepartment of Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
Pedro NaviaDepartment of Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain.
Hugo CuellarDepartment of Neurosurgery, Louisiana State University Health Sciences Center (LSUHSC), Shreveport, LA, USA.
Isabel FragataDepartment of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Adam PolifkaDepartment of Neurosurgery, University of Florida, Gainesville, FL, USA.
Joshua OsbunDepartment of Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA.
Fazeel SiddiquiDepartment of Neurology, University of Michigan Health-West, Wyoming, MI, USA.
Mark MossDepartment of Interventional Neuroradiology, Washington Regional Medical Center, Fayetteville, AR, USA.
Kaustubh LimayeDepartment of Neurology, Indiana University, Bloomington, IN, USA.
Maxim MokinDepartment of Neurosurgery, University of South Florida College of Medicine, Tampa, FL, USA.
Charles MatoukDepartment of Neurosurgery, Yale University, New Haven, CT, USA.
Min S ParkDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Waleed BrinjikjiDepartment of Neuroradiology, Mayo Clinic Minnesota, Rochester, MN, USA.
Ergun DagliogluDepartment of Neurosurgery, Ankara Bilkent City Hospital, Ankara, Turkey.
Richard WilliamsonDepartment of Neurology, Allegheny Health Network, Pittsburgh, PA, USA.
David J AltschulDepartment of Neurosurgery, Montefiore Medical Center, Bronx, NY, USA.
Christopher S OgilvyNeurosurgical Service, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA.
Roberto CrosaDepartment of Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Uruguay.
Michael R LevittDepartment of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Benjamin GoryDepartment of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France.
Alexandra PaulDepartment of Neurosurgery, Albany Medical College, Albany, NY, USA.
Peter KanDepartment of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Walter CasagrandeDepartment of Neurosurgery, Hospital Juan A. Fernandez, Buenos Aires, Argentina.
Shakeel ChowdhryDepartment of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA.
Michael F StiefelDepartment of Vascular Neurosurgery, Piedmont Healthcare Inc, Atlanta, GA, USA.
Ramesh GrandhiDepartment of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
Alejandro SpiottaDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Justin MascitelliDepartment of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.

Funding

Brain Aneurysm Foundation
6 · The paper itself

Abstract

backgroundRecent trials have furthered uncertainty regarding the endovascular benefit for medium vessel occlusions (MeVO). Stent retrievers (SR) were employed in the first attempt in most interventional arm participants. We sought to compare outcomes in acute MCA M2 occlusions between frontline aspiration and SR, and to delineate procedural and anatomical covariates associated with differential treatment effect.

methodsRetrospective analysis of a multicenter stroke thrombectomy cohort identified cases of MT for M2 occlusions. Unmatched and propensity score-matched (PSM) cohorts were generated comparing frontline aspiration to standalone and combined SR. The primary outcome was functional independence (mRS 0-2) at 90 days. Recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and the effect of M2 laterality, division occlusion and procedure time were assessed.

resultsAbout 1734 patients with M2 occlusions underwent either frontline aspiration (n = 711) or SR/combined (n = 958) thrombectomy between 2013 and 2024. PSM analysis favored aspiration for functional independence (49.9% vs 44.0%, OR 1.27 (1.03-1.57)), complete recanalization (61.2% vs 48.7%, OR 1.66 (1.34-2.05)), complete first pass effect (35.0% vs 27.6%, OR 1.42 (1.13-1.78)), and sICH (3.5% vs 6.2%, OR 0.55 (0.33-0.91)), with no difference in mortality. Frontline aspiration had significantly shorter procedural times (median 28 [IQR 15-49.5] vs 51 [IQR 35-78] minutes; p < 0.001). For every minute increase in procedure time, the probability of functional independence decreased significantly (p < 0.001) less with frontline aspiration (0.35%) compared to SR/combined (1.61%).

conclusionFrontline aspiration for M2 occlusions resulted in better clinical and angiographic outcomes compared to SRs. Future trials for MeVO with a focus on contact aspiration thrombectomy may succeed where recent trials have failed.

Indexed as

Endovascular ProceduresInfarction, Middle Cerebral ArteryThrombectomyAgedAged, 80 and overFemaleHumansMaleMiddle AgedRegistriesRetrospective StudiesStentsTreatment OutcomeaspirationMechanical thrombectomymiddle cerebral arterystent retrievers

Identifiers

PMID41614461
PMCPMC12866269

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.