Background An extensive body of evidence supports mechanical thrombectomy using stentrievers (SR) for acute large vessel occlusion (LVO). Aspiration is also utilized as a first pass technique (ADAPT) and as an adjunct technique during clot removal with a stentriever. Here we report technical results from mechanical thrombectomy cases using SR alone, aspiration alone (ADAPT), or a combination of SR plus aspiration (SA) as a first pass technique for mechanical thrombectomy for acute LVO.
Methods An institutional stroke database was reviewed for patients presenting to a single academic hospital with acute LVO and who were treated with mechanical thrombectomy from 2011 to 2017. Patients managed with stentrievers using Solitaire and Trevo (SR) alone, aspiration alone (ADAPT), or a combination of these two techniques (SA) were identified. The rate of successful recanalization, defined as TICI score 2b or greater, following the first pass thrombectomy attempt was compared between the three groups.
Results Two hundred thirty-three patients were analyzed in the study, including 135 in SR, 37 in ADAPT, and 61 in SA groups. Mean age of patients were 71±17 years for SR, 70±16 years for ADAPT, and 72±15 years for SA groups. Admission NIHSS were 17±8 for SR, 16±8 for ADAPT, and 15±6 for SA. There was no significant difference for age and admission NIHSS between the groups. Anterior circulation was involved in 207 cases (89%) and posterior circulation in 26 (11%). ADAT was utilized significantly more in posterior circulation LVO compared to the other techniques (35% in ADAPT group versus 6% and 8% in SR and SA groups respectively, p=0.000). Successful recanalization rates after first pass were 35% in SR group, 43% in ADAPT, and 61% in SA, with a statistically significant higher rate of first pass success in the SA group (p=0.003).
Conclusion The combination of stentriever and catheter aspiration can increase the rate of successful single pass recanalization compared to these techniques individually.
Disclosures G. Colby: 2; C; Stryker Neurovascular, Medtronic. H. Baharvahdat: None. R. Jahan: None. S. Tateshima: None. V. Szeder: None. M. Nour: None. F. Vinuela: None. G. Duckwiler: 2; C; Neurvana Medical, Microvention.
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