{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:02:04Z","timestamp":1792735324882,"version":"4.5.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013490","name":"Brain Aneurysm Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013490","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u20132) at 90\u2009days. Recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and the effect of M2 laterality, division occlusion and procedure time were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>About 1734 patients with M2 occlusions underwent either frontline aspiration (n\u2009=\u2009711) or SR\/combined (n\u2009=\u2009958) thrombectomy between 2013 and 2024. PSM analysis favored aspiration for functional independence (49.9% vs 44.0%, OR 1.27\u2009(1.03\u20131.57)), complete recanalization (61.2% vs 48.7%, OR 1.66\u2009(1.34\u20132.05)), complete first pass effect (35.0% vs 27.6%, OR 1.42\u2009(1.13\u20131.78)), and sICH (3.5% vs 6.2%, OR 0.55\u2009(0.33\u20130.91)), with no difference in mortality. Frontline aspiration had significantly shorter procedural times (median 28 [IQR 15\u201349.5] vs 51 [IQR 35\u201378] minutes; p\u2009&amp;lt;\u20090.001). For every minute increase in procedure time, the probability of functional independence decreased significantly (p\u2009&amp;lt;\u20090.001) less with frontline aspiration (0.35%) compared to SR\/combined (1.61%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/23969873251381924","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T11:01:18Z","timestamp":1768906878000},"source":"Crossref","is-referenced-by-count":5,"title":["Frontline aspiration versus stent retriever thrombectomy for M2 occlusions: Insights from the STAR registry"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7977-8532","authenticated-orcid":false,"given":"Michael","family":"Gaub","sequence":"first","affiliation":[{"name":"Department of Neurosurgery , University of Texas Health Science Center at San Antonio, San Antonio, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9635-7471","authenticated-orcid":false,"given":"Rahim","family":"Abo Kasem","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6988-8878","authenticated-orcid":false,"given":"Ilko","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Neurology , University Medicine Goettingen, Goettingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansaar","family":"Rai","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology , West Virginia University, Morgantown, WV ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8965-2413","authenticated-orcid":false,"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery , Thomas Jefferson University, Philadelphia, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology , Chonnam National University Hospital, Gwangju , Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Emory University School of Medicine, Atlanta, GA ,","place":["USA"]},{"name":"Department of Radiology and Imaging Sciences , Emory University School of Medicine, Atlanta, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alawieh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Emory University School of Medicine, Atlanta, GA ,","place":["USA"]},{"name":"Department of Radiology and Imaging Sciences , Emory University School of Medicine, Atlanta, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey Quintero","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Wake Forest School of Medicine, Winston Salem, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M","family":"Starke","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery , University of Miami Miller School of Medicine, Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios-Nikos","family":"Psychogios","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology , Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Shaban","sequence":"additional","affiliation":[{"name":"Department of Neurology , University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Semmes-Murphey Neurologic and Spine Institute, Memphis, TN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Dye","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Loma Linda University Health, Loma Linda, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alaraj","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , University of Illinois at Chicago, Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Ezzeldin","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences , College of Medicine, University of Houston, Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Hyogo College of Medicine, Nishinomiya ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fiorella","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , The State University of New York at Stony Brook (SUNY SB), New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Tanweer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Baylor College of Medicine, Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele G","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology , University Hospital 'San Giovanni di Dio e Ruggi d\u2019Aragona', Salerno ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Navia","sequence":"additional","affiliation":[{"name":"Department of Interventional and Diagnostic Neuroradiology , Hospital Universitario La Paz, Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Cuellar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Louisiana State University Health Sciences Center (LSUHSC), Shreveport, LA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Fragata","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology , Centro Hospitalar de Lisboa Central, Lisbon ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Polifka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , University of Florida, Gainesville, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Osbun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Washington University in Saint Louis School of Medicine, Saint Louis, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazeel","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurology , University of Michigan Health-West, Wyoming, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Moss","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology , Washington Regional Medical Center, Fayetteville, AR ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustubh","family":"Limaye","sequence":"additional","affiliation":[{"name":"Department of Neurology , Indiana University, Bloomington, IN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Mokin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , University of South Florida College of Medicine, Tampa, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Matouk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Yale University, New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min S","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , University of Virginia, Charlottesville, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Brinjikji","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology , Mayo Clinic Minnesota, Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ergun","family":"Daglioglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Ankara Bilkent City Hospital, Ankara ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Richard","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of Neurology , Allegheny Health Network, Pittsburgh, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Altschul","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Montefiore Medical Center, Bronx, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Neurosurgical Service , Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 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,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , The University of Texas Medical Branch at Galveston, Galveston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Casagrande","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , Hospital Juan A. 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