Assessing the efficacy of combined technique vs. aspiration alone: Insights from the VECTOR Trial

New data from the VECTOR randomized controlled trial, presented by Prof. Romain Bourcier at the 2023 European Stroke Organisation Conference, compared a combined mechanical thrombectomy technique using a stent retriever (Embotrap) and contact aspiration to contact aspiration alone for acute ischemic stroke patients in the context of red thrombi identified by susceptibility vessel sign on MRI.

While the study's secondary outcomes (greater first-pass reperfusion rates and greater TICI 2b-3 rates with the combined technique versus aspiration alone after the initial strategy) suggested some benefits with the combined technique, the primary efficacy endpoint of achieving high reperfusion scores (eTICI 2c/3) after the assigned first-line approach showed no significant superiority over aspiration alone.

Secondary angiographic outcomes indicated higher first-pass reperfusion rates and higher rates of eTICI 2b/3 with the combined technique after initial strategy, but no significant differences in rates of eTICI 3. Functional outcomes and safety outcomes showed no significant differences between the two groups, except for a higher rate of 24-hour symptomatic intracranial hemorrhage in the combined group.

The study raises new questions about appropriate angiographic endpoints and the impact of clot types on procedural outcomes, suggesting the need for future trials to evaluate these factors.

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