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Efficacy of Mechanical Thrombectomy Using an Aspiration Catheter Compared with a Stent Retriever Alone for Middle
Hidekazu Yamazaki1, Masafumi Morimoto2, Chiyoe Hikita2
1Department of Neurology and Neuroendovascular Treatment, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Kanagawa, Japan.
Objective:
Mechanical thrombectomy (MT) for middle cerebral artery M2 occlusion (M2O) is challenging because the procedure is performed in a narrow and tortuous artery. In this study, we compared MT using an aspiration catheter (AC) versus a stent retriever (SR) used alone, and retrospectively evaluated the efficacy and safety of MT using an AC for M2O.
Methods:
Seventy-four consecutive patients who underwent MT for M2O at our institution between April 2016 and April 2020 were evaluated. The subjects were classified into those treated by AC (AC group) or SR alone (SR group). The AC group included patients treated by both contact aspiration and a combination technique of AC and SR. Background factors and outcomes, including modified treatment in cerebral infarction (mTICI) 2c-3 recanalization, were compared between the groups.
Results:
AC and SR groups consisted of 47 and 27 patients respectively. Among them, the rate of mTICI 2b-3 was 93.6% vs 92.6%, and that of mTICI 2c-3 was 72.3% vs 48.2% (P = 0.004). The perioperative symptomatic subarachnoid hemorrhage (SAH) rate was 0% vs 7.4%, and modified Rankin scale scores of 0-2 were 78.6% vs 50% (P = 0.03). In the AC group, the mTICI 2c-3 rate was higher in patients in whom the AC was adequately advanced to the thrombus compared to those with inadequate AC advancement (83.3% vs 36.3%, P = 0.002).
Conclusion:
The rate of mTICI 2c-3 was higher in the AC than SR group, with no cases of symptomatic SAH. MT using AC for M2O might achieve safe and effective thrombectomy.
Insights
Mechanical thrombectomy using an aspiration catheter (AC) is more effective for middle cerebral artery M2 occlusions than stent retrievers alone. This approach achieved higher recanalization rates and better patient outcomes without increased complications.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Mechanical thrombectomy (MT) for middle cerebral artery M2 occlusions (M2O) presents challenges due to narrow, tortuous anatomy.
- Evaluating different MT techniques is crucial for optimizing treatment efficacy and safety.
Purpose of the Study:
- To compare the efficacy and safety of MT using an aspiration catheter (AC) versus a stent retriever (SR) alone for M2O.
- To assess outcomes including recanalization rates and functional recovery.
Main Methods:
- Retrospective evaluation of 74 patients with M2O undergoing MT between April 2016 and April 2020.
- Patients were divided into AC group (n=47) and SR alone group (n=27).
- Outcomes included modified treatment in cerebral infarction (mTICI) 2c-3 recanalization, symptomatic subarachnoid hemorrhage (SAH), and modified Rankin Scale (mRS) scores.
Main Results:
- The AC group showed a significantly higher mTICI 2c-3 recanalization rate (72.3%) compared to the SR group (48.2%) (P=0.004).
- The AC group had a lower symptomatic SAH rate (0%) versus the SR group (7.4%) and better functional outcomes (mRS 0-2: 78.6% vs 50%) (P=0.03).
- Adequate AC advancement to the thrombus in the AC group correlated with higher mTICI 2c-3 rates (83.3%).
Conclusions:
- Mechanical thrombectomy with an aspiration catheter is a safe and effective treatment for M2 occlusions.
- AC demonstrates superior recanalization rates and improved patient outcomes compared to stent retrievers alone for M2O.
- Optimizing AC advancement is key to maximizing treatment success in M2O mechanical thrombectomy.
