Effect of Stent Retriever vs Contact Aspiration on Achievement of First Pass Recanalization
Abstract
Introduction and Objective. Mechanical thrombectomy is the current standard of care for patients presenting with stroke due to large vessel occlusion. Previous studies have shown a positive association between multiple thrombectomy device passes and unfavorable clinical outcomes. This study aims to assess if the method used for mechanical thrombectomy (stent retrievers versus contact aspiration) in patients who had large vessel occlusion stroke is associated with first-pass recanalization (FPR). Methods. This is a historical cohort study of patients with large vessel occlusion who underwent mechanical thrombectomy at Baptist Health of South Florida from 2018 to 2022. The cohort consisted of patients aged 18 and older who underwent mechanical thrombectomy using either contact aspiration or stent retriever on their first device pass, and for whom key variables were available. The study compared the frequency of achieving FPR, defined as near-complete or complete reperfusion with no use of rescue therapy, between subjects undergoing contact aspiration and stent retrieval. Potential confounders were controlled for by fitting a binary multiple logistic regression model. Results. After applying exclusion criteria to 323 potentially eligible records, 238 remained in the study. Of these, 55 (23%) subjects were treated with stent retrievers, and 183 (77%) with direct aspiration. In total, 127 (53.4%) patients achieved FPR; 25 (45.5%) in the stent retriever group and 102 (55.7%) in the contact aspiration group (p=0.18). Both before and after adjustment, there was no evidence of differences in the odds of achieving FPR between stent retrievers and aspiration: unadjusted OR 1.51 (95% CI: 0.82-2.7) and adjusted OR: 1.55 (95% CI: 0.74-3.26). Conclusions-Implications. The absence of a difference in FPR with the use of stent retriever or contact aspiration in our study could be attributed to either similar device efficacy or insufficient statistical power. Further research should include a larger sample size and consider adjusting for age, operator experience, and time to groin puncture. This research can investigate the clinical implications of stent retrievers versus direct aspiration, including rates of post-procedural complications, the need for reintervention, and 90-day Rankin scores.
Keywords
First Pass Recanalization, Mechanical Thrombectomy, Stent Retriever, Contact Aspiration, Neuroradiology
Presentation Type
Poster Presentation
Effect of Stent Retriever vs Contact Aspiration on Achievement of First Pass Recanalization
Introduction and Objective. Mechanical thrombectomy is the current standard of care for patients presenting with stroke due to large vessel occlusion. Previous studies have shown a positive association between multiple thrombectomy device passes and unfavorable clinical outcomes. This study aims to assess if the method used for mechanical thrombectomy (stent retrievers versus contact aspiration) in patients who had large vessel occlusion stroke is associated with first-pass recanalization (FPR). Methods. This is a historical cohort study of patients with large vessel occlusion who underwent mechanical thrombectomy at Baptist Health of South Florida from 2018 to 2022. The cohort consisted of patients aged 18 and older who underwent mechanical thrombectomy using either contact aspiration or stent retriever on their first device pass, and for whom key variables were available. The study compared the frequency of achieving FPR, defined as near-complete or complete reperfusion with no use of rescue therapy, between subjects undergoing contact aspiration and stent retrieval. Potential confounders were controlled for by fitting a binary multiple logistic regression model. Results. After applying exclusion criteria to 323 potentially eligible records, 238 remained in the study. Of these, 55 (23%) subjects were treated with stent retrievers, and 183 (77%) with direct aspiration. In total, 127 (53.4%) patients achieved FPR; 25 (45.5%) in the stent retriever group and 102 (55.7%) in the contact aspiration group (p=0.18). Both before and after adjustment, there was no evidence of differences in the odds of achieving FPR between stent retrievers and aspiration: unadjusted OR 1.51 (95% CI: 0.82-2.7) and adjusted OR: 1.55 (95% CI: 0.74-3.26). Conclusions-Implications. The absence of a difference in FPR with the use of stent retriever or contact aspiration in our study could be attributed to either similar device efficacy or insufficient statistical power. Further research should include a larger sample size and consider adjusting for age, operator experience, and time to groin puncture. This research can investigate the clinical implications of stent retrievers versus direct aspiration, including rates of post-procedural complications, the need for reintervention, and 90-day Rankin scores.