Key result
Medium-bore aspiration catheters linked to ~13-point higher first-pass recanalization vs. small-bore catheters in stroke thrombectomy.
Why the study?
This study evaluated the longitudinal evolution of mechanical thrombectomy using a direct aspiration first pass technique and the impact of increasing aspiration catheter size.
Does increasing aspiration catheter bore size improve first-pass recanalization and groin-to-reperfusion time in patients undergoing mechanical thrombectomy with ADAPT for intracranial ICA or M1 occlusion?
Cohort (n=1,004)
No
Does increasing aspiration catheter bore size improve first-pass recanalization and groin-to-reperfusion time in patients undergoing mechanical thrombectomy with ADAPT for intracranial ICA or M1 occlusion?
In stroke mechanical thrombectomy using ADAPT, stepping up from small-bore to medium-bore aspiration catheters improves first-pass recanalization and speeds reperfusion, whereas further increases to large-bore catheters demonstrate a plateau effect.
Answers are grounded in this paper and cite their sources.
Medium-bore catheters were associated with better recanalization in ADAPT thrombectomy; extends observational data but leaves randomized confirmation open.
BACKGROUND: We present longitudinal data regarding the outcomes and evolution of mechanical thrombectomy (MT) using a direct aspiration first pass technique. OBJECTIVE: To evaluate the impact of increasing aspiration catheter size. METHODS: This is a planned analysis of a prospective cohort study that enrolled all patients who underwent a direct aspiration first pass technique MT in a comprehensive stroke center from January 2013 to December 2020. We did exploratory analysis of the characteristics and outcomes of patients who had intracranial internal carotid artery or M1 segment of middle cerebral artery occlusion based on the aspiration catheter bore size (small [041, 054, 058, and 060 inch] vs medium [0.064 and 0.068 inch] and medium vs large [0.071, 0.072, and 0.074 inch]). RESULTS: During the 8-year study period, a total of 1004 patients were included. Median age was 69 years, 49% were female patients, and 60.6% were White. Symptomatic hemorrhagic transformation was observed in 47 patients (4.7%), and 366 patients (36.5%) achieved the modified Rankin scale of 0 to 2 at 90 days after the stroke. For patients with intracranial internal carotid artery or M1 occlusion, medium-bore aspiration catheters were more likely to achieve successful recanalization after first aspiration attempt (63.9% vs 51.4%, P = .015) and had a faster groin-to-reperfusion time (16 vs 20 minutes, P = .001) when compared with small-bore catheters. However, these differences were not significant when comparing medium-bore with large-bore catheters. CONCLUSION: Medium-bore catheters had better performance measures compared with small-bore catheters. However, large-bore catheters did not show significantly better performance results that suggest a plateau effect.
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Kasab et al. (2022) conducted a cohort in Acute ischemic stroke treated with mechanical thrombectomy (including intracranial ICA or M1 MCA occlusion) (n=1,004). Medium-bore (0.064 and 0.068 inch) and large-bore (0.071, 0.072, and 0.074 inch) aspiration catheters vs. Small-bore aspiration catheters (0.041, 0.054, 0.058, and 0.060 inch) was evaluated on Successful recanalization after first aspiration attempt (p=0.015). Medium-bore aspiration catheters achieved higher first-pass recanalization and faster reperfusion than small-bore catheters in stroke thrombectomy.
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