Background The safety and effectiveness of endovascular thrombectomy (EVT) using single plane (SP) angiography systems for treatment of acute ischemic strokes (AIS) due to emergent large vessel occlusions (ELVO) has been shown in multiple retrospective studies. Functional outcomes were similar when comparing SP with biplane (BP) systems. This study assesses the safety and effectiveness of SP angiography system use for EVT during treatment of emergent medium vessel occlusions (MeVO).

Methods At a single high-volume practice, all patients with emergent MeVO treated with EVT between July 2020 and August 2022 were retrospectively included. MeVOs were defined as occlusions of A2 ACA, A3/A4 ACA, M2 MCA, M3 MCA, M3/M4 MCA, and P2 PCA. Cases were dichotomized into SP and BP treatment groups. Patient characteristics, procedural details, and outcome measures were compared. Good clinical outcomes were defined as 90-day Modified Rankin Scale (mRS) score of < 2. Successful reperfusion was defined as TICI 2b-3. Mann-Whitney U-tests were used for continuous variables. Fishers exact tests were used for categorical data.

Results 141 patients were included, with 46 treated on SP systems and 95 treated on BP systems. No significant differences were found in patient characteristics. No differences were found when comparing groin puncture to reperfusion times (SP 25 min vs BP 27 min; p = 0.97), total fluoroscopy times (SP 11.8 min vs BP 13.9 min; p = 0.09), and recanalization success rates (SP 91% vs BP 88%; p = 0.77). Procedures performed on SP systems utilized greater total radiation dosage (SP 412 mGy vs BP 217 mGy; p < 0.001) and greater contrast volumes (SP 90 mL vs BP 52 mL; p < 0.001). Rates of good clinical outcomes were similar in both groups (SP 49% vs BP 41%; p-value = 0.36). There were no differences in 24-hour NIHSS reduction (SP 3 vs BP 4; p = 0.56) or rates of periprocedural complications (SP 24% vs BP 39%; p = 0.09).

Conclusion SP angiography and BP angiography use for endovascular thrombectomy of emergent MeVOs have similar levels of safety and effectiveness. Procedural times are similar; however, SP system use results in greater total radiation dosage and greater contrast volumes.

Disclosures J. Nguyen: None. A. Denardo: None. J. Scott: None. D. Sahlein: None. K. Amuluru: None.