Efficacy of combined use of a stent retriever and aspiration catheter in mechanical thrombectomy for acute ischemic stroke.

Abstract

BACKGROUND:

The efficacy of combined stent retriever (SR) and aspiration catheter (AC; combined technique: CBT) use for acute ischemic stroke (AIS) is unclear. We investigated the safety and efficacy of single-unit CBT (SCBT)-retrieving the thrombus as a single unit with SR and AC into the guide catheter-compared with single use of either SR or contact aspiration (CA).

METHODS:

We analysed 763 consecutive patients who underwent mechanical thrombectomy for AIS between January 2013 and January 2020, at six comprehensive stroke centers. Patients were divided into SCBT and single device (SR/CA) groups. The successful recanalization with first pass (SRFP) and other procedural outcomes were compared between groups.

RESULTS:

Overall, 240 SCBT and 301 SR/CA (SR 128, CA 173) patients were analyzed. SRFP (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2c, 43.3% vs 27.9%, p<0.001; mTICI 3, 35.8% vs 25.5%, p=0.009) and final mTICI ≥2b recanalization (89.1% vs 82.0%, p=0.020) rates were significantly higher, puncture-to-reperfusion time was shorter (median (IQR) 43 (31.5-69) vs 55 (38-82.2) min, p<0.001), and the number of passes were fewer (mean±SD 1.72±0.92 vs 1.99±1.01, p<0.001) in the SCBT group. Procedural complications were similar between the groups. In subgroup analysis, SCBT was more effective in women, cardioembolic stroke patients, and internal carotid artery and M2 occlusions.

CONCLUSIONS:

SCBT increases the SRFP rate and shortens the puncture-to-reperfusion time without increasing procedural complications.

• Authors: Tomohiro Okuda, Koichi Arimura, Ryu Matsuo, So Tokunaga, Kenta Hara, Shinya Yamaguchi, Hidenori Yoshida, Ryota Kurogi, Katsuharu Kameda, Osamu Ito, Tomoyuki Tsumoto, Koji Iihara, Taichiro Mizokami, Takeshi Uwatoko, Ataru Nishimura, Katsuma Iwaki, Masahiro Mizoguchi, QNET investigators
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 14 Issue 9 Pg. 892-897 (Sep 2022) ISSN: 1759-8486 [Electronic] England
• PMID: 34544828 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Brain Ischemia (complications, diagnostic imaging, surgery)
• Catheters (adverse effects)
• Cerebral Infarction (complications)
• Endovascular Procedures
• Female
• Humans
• Ischemic Stroke
• Retrospective Studies
• Stents (adverse effects)
• Stroke (diagnostic imaging, surgery)
• Thrombectomy (adverse effects)
• Treatment Outcome