Journal Article

Contact aspiration versus stent retriever thrombectomy for acute basilar artery occlusion (ANGEL-COAST): rationale and design of a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Miao, Zhongrong, Sun, Dapeng, Song, Ligang, Ma, Ning, Liu, Liping, Zhao, Xingquan, Wang, Yilong, Mo, Dapeng, Nogueira, Raul, Xuan, Sun, Pan, Yuesong, Gao, Feng, Yang, Ming, Wang, Yongjun

2025

Overview

BackgroundContact aspiration (CA) and stent retriever (SR) thrombectomy are two equally recommended first-line endovascular techniques for treating acute ischaemic stroke due to large vessel occlusion. Whether CA is more effective in achieving complete reperfusion compared with SR in patients with acute basilar artery occlusion (ABAO) remains unclear.AimThis study aims to compare the efficacy and safety of CA versus SR as the first-line strategy during endovascular treatment in improving the rates of first-pass effect (FPE) for patients with ABAO.Methods and designThe ANGEL-COAST study is a prospective, multicentre, randomised controlled, open-label, blinded-endpoint (PROBE) clinical trial. Patients with acute ischaemic stroke due to ABAO within 24 hours from symptom onset will be recruited. Participants will be randomly assigned in a 1:1 ratio to either the CA or SR group. If the assigned treatment fails after three attempts, investigators may opt for alternative treatment strategies based on their clinical judgement.Study outcomesThe primary endpoint is the FPE rate, defined as eTICI (Extended Thrombolysis in Cerebral Infarction) 2C/3 recanalisation after the first thrombectomy attempt without any rescue strategy. Key secondary endpoints include rates of modified FPE (eTICI ≥2b50), successful recanalisation (eTICI ≥2b50, eTICI ≥2b67, eTICI3) within ≤3 passes with the assigned device on conclusion of the procedure, procedural duration, use of rescue techniques and functional outcomes at 90 days, including modified Rankin Scale (mRS) 0–2 and mRS ordinal shift analysis. Safety outcomes include the rates of symptomatic intracerebral haemorrhage (sICH) at 36±12 hours, all-cause 90-day mortality and procedure-related serious adverse events.DiscussionThis is a head-to-head randomised trial to directly compare CA and SR in ABAO. The findings will help establish the optimal first-line endovascular treatment strategy for ABAO, potentially improving clinical outcomes in this high-risk group.Trial registration numberhttps://www.clinicaltrials.gov; Unique identifier: NCT05615038.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Anesthesia / Blood clots / Blood pressure / Catheters / Data collection / Informed consent / Intervention / Ischemia / Ischemic Stroke / Medical history / Medical imaging / Patients / Protocol / Randomized Controlled Trial / Stroke / Thrombectomy / Veins & arteries