Impact of aspiration catheter inner diameter on first-pass effect: A systematic review and meta-analysis

BackgroundThe first-pass effect (FPE) refers to the complete or near-complete revascularization with a single pass of mechanical thrombectomy devices. While previous claims suggest a link between larger catheters and the effectiveness of contact aspiration (CA) thrombectomy, no extensive research has confirmed if larger distal inner diameter (ID) catheters achieve higher FPE rates.MethodsWe searched PubMed, Scopus, and Web of Science to assess the impact of aspiration catheter distal ID size on FPE. The primary outcome was FPE rate, defined as thrombolysis in cerebral ischemia (TICI) grades 2c-3 at first pass, and the secondary outcome was modified FPE (TICI 2b-3 in a single pass). Aspiration catheters were categorized based on distal ID: 0.060-0.069 (medium bore), 0.070-0.074 (large bore), and greater than 0.074 inches (super-large bore). Rates of FPE were pooled using random effect models and compared using a Chi-square test.ResultsOur study included 34 articles with 4831 patients. FPE rates were 27.7% (95% CI, 15.1-45.3) for medium bore, 46.6% (95% CI, 33.7-59.9) for large, and 58.3% (95% CI, 44.8-70.7) for super-large catheters. The FPE rate was significantly higher for super-large bore catheters compared with other groups (χ² = 7.26, p = 0.03). A similar trend was observed for modified FPE rates, which were 51.1% (95% CI, 45.3-56.8) for medium bore, 60.0% (95% CI, 52.8-66.8) for large bore, and 80% (95% CI, 56.3-94.2) for super-large bore catheters (χ² = 8.14, p = 0.03).ConclusionOur analysis indicates that larger CA catheters are correlated with higher FPE rates.