ANGEL-COAST
(2025)Objective
To compare contact aspiration versus stent retriever as first-line thrombectomy strategy for acute basilar artery occlusion
Study Summary
• Contact aspiration achieved higher first-pass effect than stent retriever (43.5% vs 27.4%, p=0.002)
• However, final recanalization was lower with aspiration (87.6% vs 94.0%, p=0.046)
• Early technical advantage of aspiration offset by lower final reperfusion rates
• However, final recanalization was lower with aspiration (87.6% vs 94.0%, p=0.046)
• Early technical advantage of aspiration offset by lower final reperfusion rates
Intervention
First-line contact aspiration vs first-line stent retriever thrombectomy
Inclusion Criteria
Basilar artery occlusion, <24h window, age ≥18, NIHSS ≥10, PC-ASPECTS ≥6, pre-stroke mRS ≤2
Study Design
Arms: Contact aspiration vs Stent retriever
Patients per Arm: 170 contact aspiration, 168 stent retriever
Outcome
• Primary: First-pass effect (eTICI 2c/3) 43.5% vs 27.4% (OR 2.04, 95% CI 1.30–3.22, p=0.002)
• Per-protocol FPE: 49.7% vs 27.2% (OR 2.65, 95% CI 1.65–4.24, p<0.001)
• Final recanalization (eTICI ≥2b50): 87.6% vs 94.0% (OR 0.45, 95% CI 0.21–0.99, p=0.046)
• Per-protocol FPE: 49.7% vs 27.2% (OR 2.65, 95% CI 1.65–4.24, p<0.001)
• Final recanalization (eTICI ≥2b50): 87.6% vs 94.0% (OR 0.45, 95% CI 0.21–0.99, p=0.046)