Introduction Three major mechanical thrombectomy (MT) techniques are currently used: stent retriever (SR) only, aspiration (ASP) only, and combination therapy (CT) with a general goal of achieving first-pass recanalization (FPR: TICI≥2c). The superiority of one MT technique over another, as well as the optimal aspiration method (manual aspiration vs. aspiration pump) is poorly understood.

Methods INSPIRE-S is a prospective, imaging core-lab/safety clinical events committee adjudicated, global registry of stroke patients treated with Medtronic Neurovascular devices on the first pass and grouped according to initial MT technique. There are some pre-clinical studies assessing differences in outcomes comparing manual vs aspiration pump, however, real-world evidence on differences with aspiration method (manual aspiration vs aspiration pump) are not well known.

Results From May 2020 to April 2023, 802 patients (30 sites/13 countries) were enrolled: SR:259, ASP:146 and CT:397. MCA-M1/M2 occlusions were present in 76.1%. Among the 3 technique cohorts, final complete revascularization rates (eTICI≥2c) were: 75.9%, 67.8% and 71.6% respectively (p=0.016 comparing ASP vs. SR technique, p=0.049 comparing 3 techniques). Good clinical outcome (mRS≤2) at 90 days was achieved in 60.9%, 52.8%, and 57.0% respectively. For aspiration method with ASP technique, use of aspiration pump was associated with improved mRS 0–2 at 90 days compared to manual aspiration (59.8% vs. 36%, p=0.0084) with no significant differences in final revascularization (eTICI≥2c; 68.1% vs. 67.3%) or first-pass revascularization (44.0% vs. 46.2%). Similar findings were observed for use of aspiration pump in combination technique in mRS 0–2 (59.1% vs. 49.1%, p=0.062).

Conclusions The primary results of real-world data from INSPIRE-S among a large and varied patient population demonstrated comparable outcomes according to first line MT technique overall. When looking at recanalization outcomes between manual aspiration vs aspiration pump, there were no differences; however, a notable difference in mRS outcomes suggesting differences in safety profile that is being currently explored and will be presented at SNIS.

Disclosures M. Ribo: 2; C; Medtronic, Stryker, Johnson and Johnson, Perflow Medical, Anaconda Biomed, Apta Targets, Ceronovus, Philips, Sanofi, Rapid AI.