First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy

Introduction Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusion...

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Published in:	Clinical neuroradiology (Munich) Vol. 33; no. 3; pp. 701 - 708
Main Authors:	Remollo, S., Werner, M., Blasco, J., López-Rueda, A., San Roman, L., Jimenez-Gomez, E., Bravo Rey, I., Vega, P., Murias, E., Rosati, S., Pérez-García, C., González, E., Manso, X., Aixut, S., Chirife Chaparro, O., Terceño, M., Bashir, S., Pumar, J. M., Ruiz-González, E., Méndez, J. C., Aguilar Tejedor, Y., Zamarro, J., Castaño, M., Daunis-I-Estadella, P., Puig, J.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2023 Springer Nature B.V
Subjects:	Catheters Clinical outcomes Medicine Medicine & Public Health Neurology Neuroradiology Neurosurgery Original Article Stroke Treatment Ischemia Recovery Endovascular Outcome
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Summary:	Introduction Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. Methods We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″–0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″–0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c–3) after a single pass of the device. Results We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P  = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P  = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P  = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250–3.143, P  = 0.004). Conclusion Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1869-1439 1869-1447
DOI:	10.1007/s00062-023-01264-4