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Ischemic stroke
Original research
Efficacy of combined use of a stent retriever and aspiration catheter in mechanical thrombectomy for acute ischemic stroke
  1. Tomohiro Okuda1,
  2. Koichi Arimura1,
  3. Ryu Matsuo2,
  4. So Tokunaga3,
  5. Kenta Hara3,
  6. Shinya Yamaguchi4,
  7. Hidenori Yoshida5,
  8. Ryota Kurogi5,
  9. Katsuharu Kameda6,
  10. Osamu Ito6,7,
  11. Tomoyuki Tsumoto3,8,
  12. Koji Iihara1,9,
  13. Taichiro Mizokami10,
  14. Takeshi Uwatoko11,
  15. Ataru Nishimura1,
  16. Katsuma Iwaki1,
  17. Masahiro Mizoguchi1
  18. QNET investigators
  1. 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  2. 2Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  3. 3Department of Neuroendovascular Therapy, National Hospital Organisation Kyushu Medical Center, Fukuoka, Fukuoka, Japan
  4. 4Department of Neurosurgery, Steel Memorial Yawata Hospital, Kita-Kyushu, Fukuoka, Japan
  5. 5Department of Neurosurgery, Fukuoka Tokushukai Medical Center, Kasuga, Fukuoka, Japan
  6. 6Department of Neurosurgery, Shin Koga Hospital, Kurume, Fukuoka, Japan
  7. 7Department of Neurosurgery, Kieikai Hospital, Fukuoka, Japan
  8. 8Department of Neurosurgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
  9. 9Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan
  10. 10Department of Neurosurgery, Saga -Ken Medical Centre Koseikan, Saga, Saga, Japan
  11. 11Department of Cerebrovascular Medicine, Saga Prefecture Medical Center Koseikan, Saga, Saga, Japan
  1. Correspondence to Dr Koichi Arimura, Neurosurgery, Kyushu University, Fukuoka 812-8582, Japan; karimura{at}ns.med.kyushu-u.ac.jp

Abstract

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.

  • catheter
  • stroke
  • intervention
  • thrombectomy

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017837

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • 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.

    • 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.