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Ischemic stroke
Original research
Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy
  1. Derrek Schartz1,
  2. Nathaniel Ellens2,
  3. Gurkirat Singh Kohli2,
  4. Redi Rahmani2,
  5. Sajal Medha K Akkipeddi2,
  6. Geoffrey P Colby3,
  7. Ferdinand Hui4,
  8. Tarun Bhalla2,
  9. Thomas Mattingly2,
  10. Matthew T Bender2
  1. 1 Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
  2. 2 Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
  3. 3 Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
  4. 4 Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
  1. Correspondence to Dr Matthew T Bender; matthew_bender{at}urmc.rochester.edu

Abstract

Background Direct aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood.

Methods A systematic literature review and meta-regression analysis was completed to evaluate the impact of primary aspiration thrombectomy outcomes based on the ID of the aspiration catheter. Primary outcome measures were: final recanalization of modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3 with aspiration only and with rescue modalities, first pass effect (FPE), need for rescue modalities, intracranial hemorrhagic complication rates, and functional outcomes of 90-day modified Rankin Scale (mRS) of 0–2.

Results 30 studies were identified with 3228 patients. Meta-regression analysis revealed a significant association between increasing aspiration catheter ID and FPE (p=0.032), between ID and final recanalization with aspiration only (p=0.05), and between ID size and recanalization including cases with rescue modalities (p=0.002). Further, subgroup analysis indicated that catheters with an ID ≥0.064 inch had a lower rate of need for rescue than smaller catheters (p=0.013). Additionally, catheters with an ID ≥0.068 inch had a higher rate of intracranial bleeding complications (p=0.025). Lastly, no significant association was found in functional outcomes overall.

Conclusions Larger aspiration catheters are associated with a higher rate of FPE, final recanalization with only an aspiration catheter, and in cases with rescue modalities, though with a higher rate of hemorrhagic complications. These findings confirm that aspiration catheter size functions as a variable in aspiration thrombectomy, which should be considered in future study and trial design.

  • Catheter
  • Thrombectomy
  • Stroke
  • Intervention
  • Device

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2022-019246

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors Study concept and design: DS, MTB. Data collection: DS, NE. Data analysis: DS, MTB. Manuscript writing: DS, MTB. Manuscript editing and appraisal: all authors. Guarantor DS and MTB.

    • 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 GPC reports being a consultant for Stryker Neurovascular, Balt, Rapid Medical, Medtronic, and MicroVention.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.