Citations 2
First-pass aspiration versus stent retriever thrombectomy: machine learning study of treatment effect heterogeneity
Chen, Huanwen , Isidor, Julio , Schirmer, Clemens, Ernst, Marielle , Rai, Ansaar, Jabbour, Pascal , Abecassis, Isaac Josh , Grossberg, Jonathan A , Alawieh, Ali, Khanna, Omaditya, Starke, Robert M, Psychogios, Marios-Nikos, Siddiqui, Fazeel, Samaniego, E, Goyal, Nitin, Ezzeldin, Mohamad , Dye, Justin, Alcedo, Rodolfo, Cerejo, Russell , Luther, Evan, Romano, Daniele G, Tanweer, Omar, Mascitelli, Justin, Cuellar, Hugo H, Chalouhi, Nohra , Limaye, Kaustubh, Kellogg, Ryan, Brinjikji, Waleed, Chowdhry, Shakeel , Spiotta, Alejandro M , Kan, Peter , Jabbour, Pascal , Abecassis, Isaac Josh , Grossberg, Jonathan A , Navia, Pedro , Ezzeldin, Mohamad , Alaraj, Ali , Yoshimura, Shinichi , Fiorella, David , Fragata, Isabel , Mokin, Maxim , Matouk, Charles , Chowdhry, Shakeel A , Altschul, David J , Ogilvy, Christopher S , Levitt, Michael R , Grandhi, Ramesh , Spiotta, Alejandro M , Kan, Peter , Kim, Jae‐Joong , Rai, Ansaar , Jabbour, Pascal , Navía, Pedro , Starke, Robert M. , Psychogios, Marios‐Nikos , Goyal, Nitin , Dye, Justin , Alaraj, Ali , Yoshimura, Shinichi , Almallouhi, Eyad , Fiorella, David , Romano, Daniele Giuseppe , Tanweer, Omar , Fragata, Isabel , Mascitelli, Justin R , Limaye, Kaustubh , Matouk, Charles , Kellogg, Ryan Thomson , Brinjikji, Waleed , Altschul, David , Ogilvy, Christopher S. , Levitt, Michael R. , Grandhi, Ramesh
Journal of NeuroInterventional Surgery | July 24, 2026 | Volume: No volume available | Issue: No issue available | Pages: jnis-2026-025615
Background Randomized trials have shown equivocal outcomes between a direct aspiration as first-pass technique (ADAPT) and stent retriever (SR) stroke thrombectomy, yet whether specific patient subgroups benefit differentially from one technique over the other remains unknown. Methods In this retrospective multicenter cohort study, patients with large vessel occlusion were included, and those who underwent ADAPT versus SR first-pass thrombectomy (either as standalone or combined with aspiration) were compared. The primary outcome was a composite of first-pass effect (FPE, modified Thrombolysis In Cerebral Infarction (mTICI) 2c or better with one attempt) with no symptomatic intracranial hemorrhage (sICH). A causal forest model was used to estimate the conditional average treatment effect (CATE) for each patient, with larger CATEs indicating that ADAPT is expected to be more advantageous. Patients were stratified by CATEs, and outcomes were compared between treatment groups. Results Among 6700 included patients, ADAPT (n=3695, 55%) was associated with a higher rate of FPE with no sICH (39.9% vs 26.9%; adjusted OR (aOR) 2.07, 95% CI 1.77 to 2.41, P<0.001). The causal forest identified significant treatment effect heterogeneity (interaction P<0.001), where ADAPT was more advantageous in more recent years and among patients with M1 occlusions presenting in earlier time windows. Low-CATE patients showed no statistically significant difference between techniques (aOR 0.91, 95% CI 0.57 to 1.45, P=0.70), while medium- and high-CATE patients demonstrated progressively larger ADAPT advantages (aOR 2.06, 95% CI 1.67 to 2.55, and aOR 2.99, 95% CI 2.24 to 3.98, respectively, both P<0.001). Conclusions ADAPT may be superior to SR for a majority of patients, particularly in recent years, and among patients with M1 occlusions presenting in earlier time windows.
Endovascular Thrombectomy With and Without Preceding Thrombolysis in Posterior Circulation Stroke—Insights From STAR
Heide, Ev‐Christin , Brinjikji, Waleed , Chowdhry, Shakeel , Dumont, Travis M., Ernst, Marielle , Ezzeldin, Mohamad , Kan, Peter, Kim, Joon‐Tae , Moss, Mark, Polifka, Adam , Psychogios, Marios‐Nikos , Rai, Ansaar , Starke, Robert M. , Tanweer, Omar , Williamson, Richard A., Spiotta, Alejandro M , Maier, Ilko , Investigators, STAR, Kasab, Sami Al , Alawieh, Ali , Arthur, Adam Stephen , Crosa, Roberto , Cuellar, Hugo , Leacy, Reade De , Fragata, Isabel , Howard, Brian M , Jabbour, Pascal , Levitt, Michael R. , Mascitelli, Justin R , Matouk, Charles , Navía, Pedro , Osbun, Joshua W , Park, Min S. , Romano, Daniele G., Shaban, Amir , Williamson, Richard, Wolfe, Stacey Q , Yoshimura, Shinichi , Investigators, STAR
Stroke: Vascular and Interventional Neurology | July 16, 2024 | Volume: 4 | Issue: 5 | Pages: No page available
Background Multiple randomized trials could not establish the noninferiority of endovascular thrombectomy (EVT) alone without preceding intravenous thrombolysis (IVT) or superiority of IVT followed by EVT in anterior circulation large‐vessel occlusion stroke. The role of prior IVT in posterior circulation large‐vessel occlusion remains controversial. Methods In this multicenter, retrospective study, patients with stroke with large‐vessel occlusion in the posterior circulation who received EVT alone or with IVT were selected from the stroke thrombectomy and aneurysm registry between 2013 and 2022. Effects of IVT followed by thrombectomy on favorable functional outcome (defined as modified Rankin scale≤3 at 90 days) and safety were investigated using multivariable logistic and linear regression models. Results Of the 588 included patients, 67% (n = 394) were treated with EVT alone and 29% (n = 170) with EVT after IVT, and 4% (n = 24) have missing values on this variable. Controlling for multiple confounding factors, IVT was not associated with a higher likelihood of favorable functional outcome at 90 days (odds ratio, 1.04 [95% CI, 0.52–2.09; P = 0.901). Thrombectomy alone did not show any safety advantages compared with those receiving IVT. Conclusion Similar functional outcomes and complication rates were seen in patients with posterior circulation large‐vessel occlusion treated with EVT alone versus EVT after IVT. Further prospective studies are required to determine the utility of IVT in posterior circulation stroke, especially in patients being directly admitted to thrombectomy centers.