Background The efficacy of combined stent retriever (SR) and aspiration catheter (AC; combined technique: CBT) use for acute ischemic stroke (AIS) is unclear. We investigated the safety and efficacy of single-unit CBT (SCBT)—retrieving the thrombus as a single unit with SR and AC into the guide catheter—compared with single use of either SR or contact aspiration (CA).
Methods We analysed 763 consecutive patients who underwent mechanical thrombectomy for AIS between January 2013 and January 2020, at six comprehensive stroke centers. Patients were divided into SCBT and single device (SR/CA) groups. The successful recanalization with first pass (SRFP) and other procedural outcomes were compared between groups.
Results Overall, 240 SCBT and 301 SR/CA (SR 128, CA 173) patients were analyzed. SRFP (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2c, 43.3% vs 27.9%, p<0.001; mTICI 3, 35.8% vs 25.5%, p=0.009) and final mTICI ≥2b recanalization (89.1% vs 82.0%, p=0.020) rates were significantly higher, puncture-to-reperfusion time was shorter (median (IQR) 43 (31.5–69) vs 55 (38–82.2) min, p<0.001), and the number of passes were fewer (mean±SD 1.72±0.92 vs 1.99±1.01, p<0.001) in the SCBT group. Procedural complications were similar between the groups. In subgroup analysis, SCBT was more effective in women, cardioembolic stroke patients, and internal carotid artery and M2 occlusions.
Conclusions SCBT increases the SRFP rate and shortens the puncture-to-reperfusion time without increasing procedural complications.
Data availability statement
Data are available upon reasonable request.
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Collaborators QNET investigators; Kyushu University: Koji Yoshimoto, MD, PhD, Masahiro Mizoguchi, MD, PhD, Koichi Arimura, MD, PhD, Ataru Nishimura, MD, PhD, Katsuma Iwaki, MD, Tomohiro Okuda, MD, Yuya Koyanagi, MD. Kyushu Medical Center: So Tokunaga, MD, Kenta Hara, MD. Saga-ken Medical Center Koseikan: Taichiro Mizokami, MD, PhD, Takeshi Uwatoko, MD, Keisuke Ido, MD.
Fukuoka Tokushukai Hospital: Hidenori Yoshida, MD, Ryota Kurogi, MD, PhD. Steel Memorial Yawata Hospital: Shinya Yamaguchi, MD. Shin Koga Hospital: Katsuharu Kameda, MD, PhD. Kieikai Hospital: Osamu Ito, MD, PhD. Aso Iizuka Hospital: Masanori Kai, MD, PhD.
Contributors All authors meet the ICMJE authorship criteria. TO designed this study and wrote the initial draft of the manuscript. All other authors critically reviewed the manuscript and assisted in the preparation of the manuscript. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This work was supported by JSPS KAKENHI (Grant number, JP20K09350), Daiwa Securities Health Foundation (Grant number, 20204723), and Bristol Myers Squibb Research grant (Grant number, 60961775).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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