Journal article
Frontline aspiration versus stent retriever thrombectomy for M2 occlusions: Insights from the STAR registry
European stroke journal, Vol.11(1), 23969873251381924
01/01/2026
DOI: 10.1093/esj/23969873251381924
Abstract
Background Recent 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. Methods Retrospective 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. Results About 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%). Conclusion Frontline 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.
Details
- Title: Subtitle
- Frontline aspiration versus stent retriever thrombectomy for M2 occlusions: Insights from the STAR registry
- Creators
- Michael Gaub - The University of Texas Health Science Center at San AntonioPedro Navia - Hospital Universitario La PazHugo Cuellar - Louisiana State UniversityRahim Abo Kasem - University of South CarolinaIlko Maier - Universitätsmedizin GöttingenIsabel Fragata - Ctr Hosp Lisboa Cent, Dept Neuroradiol, Lisbon, PortugalAnsaar Rai - West Virginia UniversityAdam Polifka - University of FloridaJoshua Osbun - Washington Univ, Dept Neurosurg, Sch Med, St Louis, MO USAPascal Jabbour - Thomas Jefferson UniversityJoon-Tae Kim - Chonnam Natl Univ Hosp, Dept Neurol, Gwangju, South KoreaFazeel Siddiqui - University of MichiganBrian Howard - Emory UniversityMark Moss - Washington Reg Med Ctr, Dept Intervent Neuroradiol, Fayetteville, AR USAAli Alawieh - Emory UniversityKaustubh Limaye - Indiana University BloomingtonStacey Quintero Wolfe - Wake Forest UniversityMaxim Mokin - Univ S Florida, Coll Med, Dept Neurosurg, Tampa, FL USARobert M. Starke - University of MiamiCharles Matouk - University of New HavenMarios-Nikos Psychogios - Univ Hosp Basel, Dept Neuroradiol, Clin Radiol & Nucl Med, Basel, SwitzerlandMin S. Park - University of VirginiaWaleed Brinjikji - Mayo Clin Minnesota, Dept Neuroradiol, Rochester, MN USAAmir Shaban - University of IowaNitin Goyal - The Spine InstituteErgun Daglioglu - AnkaraJustin Dye - Loma Linda UniversityRichard Williamson - Allegheny Hlth Network, Dept Neurol, Pittsburgh, PA USAAli Alaraj - University of Illinois ChicagoDavid J. Altschul - Montefiore Med Ctr, Dept Neurosurg, Bronx, NY USAMohamad Ezzeldin - University of HoustonChristopher S. Ogilvy - Beth Israel Deaconess Med Ctr BIDMC, Neurosurg Serv, Boston, MA USAShinichi Yoshimura - Hyogo Coll Med, Dept Neurosurg, Nishinomiya, JapanRoberto Crosa - Med Uruguaya, Dept Endovasc Neurosurg, Montevideo, UruguayDavid Fiorella - Stony Brook UniversityMichael R. Levitt - University of WashingtonOmar Tanweer - Baylor College of MedicineBenjamin Gory - CHRU Nancy, Dept Diagnost & Intervent Neuroradiol, Nancy, FranceDaniele G. Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaAlexandra Paul - Albany Medical CollegeWalter Casagrande - Hospital FernándezShakeel Chowdhry - NorthShore Univ HealthSyst, Dept Neurosurg, Evanston, IL USAMichael F. Stiefel - Piedmont HealthCareRamesh Grandhi - University of UtahAlejandro Spiotta - University of South CarolinaJustin Mascitelli - The University of Texas Health Science Center at San AntonioStroke Thrombectomy Aneurysm Registry STAR Collaborators
- Resource Type
- Journal article
- Publication Details
- European stroke journal, Vol.11(1), 23969873251381924
- DOI
- 10.1093/esj/23969873251381924
- ISSN
- 2396-9873
- eISSN
- 2396-9881
- Publisher
- Sage
- Number of pages
- 13
- Grant note
- Brain Aneurysm Foundation
- Language
- English
- Date published
- 01/01/2026
- Academic Unit
- Neurology
- Record Identifier
- 9985121596502771
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