First Pass Recanalization Rates of Solitaire vs Trevo vs Primary Aspiration: The Kaiser Southern California...

Area of Science:

• Neuroendovascular surgery
• Interventional neurology
• Cerebrovascular disease

Background:

• Mechanical thrombectomy significantly improves outcomes for large vessel occlusion (LVO) stroke.
• The first pass effect (FPE) is crucial for successful recanalization and better patient prognosis.
• Optimal thrombectomy technique for achieving FPE remains under investigation.

Purpose of the Study:

• To compare the first pass recanalization rates of three common thrombectomy techniques: Solitaire stent-retriever, Trevo stent-retriever, and primary aspiration (PA).
• To evaluate the efficacy of these techniques in achieving successful recanalization in a single pass for LVO stroke patients.

Main Methods:

• Retrospective review of LVO stroke cases treated between October 2013 and May 2018.
• Analysis of successful recanalization rates after a single device pass for Solitaire, Trevo, and PA techniques.
• Statistical comparison of FPE rates, adjusting for patient demographics and stroke severity.

Main Results:

• First pass success rates were 45% for Solitaire, 31% for Trevo, and 39% for PA, with no statistically significant difference (p=0.26).
• Adjusted analysis showed a trend favoring Solitaire over Trevo (OR 1.90, p=0.09) and aspiration over Trevo (OR 1.41, p=0.33).
• No technique demonstrated statistically significant superiority in achieving first pass recanalization.

Conclusions:

• This multi-center study found no statistically significant difference in first pass recanalization rates among Solitaire, Trevo, and PA.
• A trend towards improved efficacy was observed with the Solitaire device compared to Trevo.
• Further research is needed to identify specific conditions where device design may influence technique effectiveness.