First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration
S Remollo1, M Werner1, J Blasco2
1Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Insights
Using larger aspiration catheters in mechanical thrombectomy for stroke significantly improves the first-pass effect (FPE) rate, leading to better reperfusion outcomes. This study highlights the benefit of extra-large-bore distal aspiration catheters (extra-LB-DAC) in stroke treatment.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Cardiovascular Diseases
Background:
- Mechanical thrombectomy is a key treatment for large-vessel occlusion (LVO) stroke.
- Combined stent-retriever and large-bore distal aspiration catheter (LB-DAC) techniques are used for LVO.
- The impact of larger inner diameter aspiration catheters on outcomes remains unclear.
Purpose of the Study:
- To compare angiographic and clinical outcomes of mechanical thrombectomy using extra-large-bore distal aspiration catheters (extra-LB-DAC) versus standard LB-DAC.
- To evaluate the effect of catheter inner diameter on the first-pass effect (FPE) in middle cerebral artery M1 segment occlusions.
Main Methods:
- Retrospective analysis of 324 patients with M1 occlusion from the ROSSETTI registry (June 2019-April 2022).
- Comparison between patients treated with extra-LB-DAC (0.068″-0.070″) and LB-DAC (0.055″-0.064″).
- Primary outcome: first-pass effect (FPE) rate (mTICI 2c-3 after single pass).
Main Results:
- Extra-LB-DAC group showed a significantly higher FPE rate (47% vs. 30.9%, P=0.003) and modified FPE rate (65.9% vs. 46.8%, P=0.001).
- A trend towards improved 24-hour National Institutes of Health Stroke Scale scores was observed with extra-LB-DAC (9 vs. 12 points, P=0.083).
- Use of extra-LB-DAC was an independent predictor of FPE (OR 1.982, P=0.004).
Conclusions:
- Larger inner diameter aspiration catheters in combined thrombectomy are associated with higher rates of first-pass reperfusion.
- Extra-LB-DAC may improve procedural efficiency and early neurological recovery in LVO stroke.
- Catheter size is a critical factor in optimizing thrombectomy outcomes.
Introduction:
Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers.
Methods:
We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device.
Results:
We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004).
Conclusion:
Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
