ArticleCardiovascular and interventional radiology2026
First-Line Thrombectomy for Acute Intracranial Atherosclerotic Stenosis-Related Vertebrobasilar Artery Occlusion: Stent Retriever-Based Versus Contact Aspiration Thrombectomy Strategies.
Article in Cardiovascular and interventional radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo compare procedural and clinical outcomes of first-line contact aspiration thrombectomy (CAT) versus a stent retriever-based strategy in acute intracranial atherosclerotic stenosis (ICAS)-related vertebrobasilar artery occlusion (VBAO). MATERIALS AND
methodsThis retrospective two-center study included consecutive patients with acute ICAS-related VBAO treated between 2019 and 2024. Patients were classified by first-line strategy as CAT or an SRT-based strategy comprising stent retriever thrombectomy alone or with aspiration assistance. Primary outcomes were first-pass recanalization (FPR; modified Thrombolysis in Cerebral Infarction grade ≥ 2b after one device pass) and 90-day favorable functional outcome (modified Rankin Scale score 0-3). Multivariable regression was used for outcome comparisons, with inverse probability weighting (IPW) as a sensitivity analysis.
resultsAmong 129 patients, 38 received CAT and 91 received an SRT-based strategy. FPR was higher with the SRT-based strategy than with CAT (74.7% vs. 52.6%; adjusted odds ratio [aOR], 2.66; 95% CI, 1.15-6.16; p = 0.022). The 90-day favorable outcome did not differ significantly (48.4% vs. 36.8%; aOR, 1.69; 95% CI, 0.71-4.02; p = 0.235). In the primary adjusted analysis, the SRT-based strategy was associated with lower 90-day mortality (19.8% vs. 34.2%; aOR, 0.37; 95% CI, 0.15-0.96; p = 0.041), fewer strategy switches (1.1% vs. 34.2%; p < 0.001), and shorter puncture-to-recanalization time (63.0 vs. 73.5 min; p = 0.003). IPW supported these procedural advantages, whereas clinical outcome differences were nonsignificant.
conclusionIn acute ICAS-related VBAO, a first-line SRT-based strategy was associated with better procedural performance than CAT, including higher first-pass recanalization, fewer strategy switches, and shorter puncture-to-recanalization time.
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