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Mechanical Thrombectomy Making Practical Use of an Aspiration Catheter While Selecting the Retrieval Technique during
Tatsuya Ogino1,2, Koichiro Shindo1,2, Yasuyuki Tatsuta1,2
1Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan.
Insights
Aspiration catheters (AC) combined with stent retrievers (SR) improved thrombectomy outcomes for cerebral anterior circulation arterial occlusions. This approach increased first-pass reperfusion and reduced the number of passes needed for successful clot removal.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Cerebral anterior circulation arterial occlusions require prompt reperfusion to prevent ischemic damage.
- Mechanical thrombectomy is a standard treatment, with stent retrievers (SR) and aspiration catheters (AC) being key devices.
Purpose of the Study:
- To compare the outcomes of endovascular thrombectomy using different retrieval techniques for major cerebral anterior circulation artery occlusions.
- To evaluate the impact of incorporating aspiration catheters (AC) into the thrombectomy strategy.
Main Methods:
- Retrospective analysis of 102 patients undergoing thrombectomy for anterior circulation occlusions between 2018-2019.
- Patients were divided into an earlier group (SR-alone) and a later group (AC-based techniques).
- The later group utilized a combined SR and AC approach when feasible, otherwise employing contact aspiration.
Main Results:
- The later group achieved a higher rate of Thrombolysis in Cerebral Infarction (TICI) grade 2b-3 at first pass (71% vs. 46%).
- The mean number of passes required for successful reperfusion significantly decreased in the later group (1.32 vs. 1.84).
- Overall TICI 2b-3 reperfusion rates were high in both groups (85% vs. 95%), with no significant difference in TICI 3 rates.
Conclusions:
- Employing aspiration catheters from the outset, and a combined technique when possible, enhances thrombectomy efficacy.
- This strategy increases the likelihood of successful reperfusion on the first attempt and reduces procedural complexity.
Objective:
To report the outcomes of thrombectomy for arterial occlusion involving the major arteries of the cerebral anterior circulation when an aspiration catheter (AC) was used in all cases, with the retrieval technique chosen during the procedure.
Methods:
Of the 126 patients who underwent endovascular thrombectomy during the 2-year period of 2018-2019, the study subjects were 102 patients with arterial occlusion involving the major arteries of the cerebral anterior circulation. Patients were divided into two groups depending on when the procedure was performed. In the earlier group (January 2018-March 2019), treatment was performed using only a stent retriever (SR), whereas an AC was used for all cases in the later group (April-December 2019). Outcomes between groups were retrospectively compared. In the later group, the treatment strategy was to use the SR in combination with the AC (combined technique) for retrieval if the microcatheter reached the distal side of the occlusion site without difficulty. If the microcatheter did not easily reach the distal side, we did not stick to penetrating the occlusion site, and contact aspiration was performed.
Results:
Thrombolysis in cerebral infarction (TICI) grade 2b-3 was achieved in 85% of patients in the earlier group and 95% in the later group. TICI grade 3 was achieved in 52% of the earlier group and 54% of the later group, showing no significant difference. TICI grade 2b-3 was achieved at first pass in 46% of patients in the earlier group, significantly lower than the 71% in the later group (P = 0.013). The mean number of passes decreased significantly from 1.84 in the earlier group to 1.32 in the later group (P = 0.002).
Conclusion:
Using an AC from the start, and using a combined technique when the microcatheter reached the distal side of the occlusion site, the frequency of first-pass TICI grade 2b-3 increased, and the mean number of passes decreased in comparison with the SR-alone group.
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