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Original research
Comparison of aspiration-first versus stentriever-first techniques in performing mechanical thrombectomy for large vessel occlusions
  1. Vance L Fredrickson1,2,
  2. Phillip A Bonney2,
  3. Shivani D Rangwala2,
  4. Joshua S Catapano1,
  5. Tyler S Cole1,
  6. Daniel D Cavalcanti1,
  7. Neil Majmundar1,
  8. D. Andrew Wilkinson1,
  9. Luis San Roman1,
  10. Michael F Waters1,
  11. Felipe C Albuquerque1,3,
  12. Andrew F Ducruet1,3
  1. 1 Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  2. 2 Neurological Surgery, USC Keck School of Medicine, Los Angeles, California, USA
  3. 3 Neurosurgery, Honor Health Scottsdale Osborn Medical Center, Scottsdale, AZ, USA
  1. Correspondence to Dr Andrew F Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona 85013, USA; andrew.ducruet{at}


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.

  • device
  • stroke
  • technique
  • thrombectomy

Data availability statement

No data are available. There are no additional data to share.

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Data availability statement

No data are available. There are no additional data to share.

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  • Contributors VLF and AFD: all aspects of the study and manuscript writing. PB: statistics and manuscript prep. SDR, JSC, TSC, NM, and DAW: manuscript prep. DDC: data gathering. LSR: data gathering and study design. MFW and FCA: study design.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AFD is a consultant for Penumbra, Medtronic, Cerenovus, Stryker, and Koswire.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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