Title

Comparison of aspiration-first versus stentriever-first techniques in performing mechanical thrombectomy for large vessel occlusions

Document Type

Article

Abstract

BACKGROUND: Both stentriever and direct-aspiration thrombectomy effectively treat large-vessel occlusions. However, data are limited comparing clinical outcomes after aspiration-first versus stentriever-assisted aspiration for thrombectomy. METHODS: A retrospective cohort study compared procedure times and radiographic outcomes after two mechanical thrombectomy techniques (aspiration first or stentriever). To minimize bias and variability inherent to multi-operator series, we assessed consecutive patients with cerebrovascular occlusions treated by a single surgeon during a 1 year period at two stroke centers. Expanded Thrombolysis in Cerebral Infarction (eTICI) grades were assessed by an investigator blinded to treatment. RESULTS: Data from 93 patients (median age 70 years) were analyzed: 73 patients (78.5%) were treated with a strentriever-first strategy and 20 (21.5%) were treated with aspiration first, with stentriever rescue therapy required in only three of these cases following unsuccessful aspiration. There were no significant differences in patient demographics, sites of occlusion, or rates of tandem occlusions between aspiration-first and stentriever-assisted groups (p≥0.36). The rate of first-pass eTICI ≥2b was 75.0% (15/20) for aspiration-first and 52.1% (38/73) for strentriever-first groups (p=0.07), while the rate of final eTICI ≥2b was 100% (20/20) and 82.2% (60/72), respectively (p=0.04). The aspiration-first technique was associated with procedural times ≤25 min in a multivariable analysis (adjusted OR 4.77, 95% CI 1.15 to 18.39; p=0.03). CONCLUSIONS: In this single-surgeon series, an aspiration-first technique was associated with a statistically significant improvement in eTICI outcomes and faster procedure times compared with stentriever-assisted aspiration. Further prospective studies are necessary to minimize selection bias inherent in this study design.

Keywords

device, stroke, technique, thrombectomy

Medical Subject Headings

Aged; Aged, 80 and over; Cerebrovascular Disorders (diagnostic imaging, surgery); Cohort Studies; Female; Humans; Male; Middle Aged; Paracentesis (methods); Prospective Studies; Retrospective Studies; Stents; Thrombectomy (methods); Treatment Outcome; Vascular Access Devices

Publication Date

7-1-2021

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

13

Issue

7

First Page

614

Last Page

618

PubMed ID

32958518

Digital Object Identifier (DOI)

10.1136/neurintsurg-2020-016547

This document is currently not available here.

Share

COinS