Endovascular thrombectomy first-pass reperfusion and ancillary device placement

Area of Science:

• Interventional Neurology
• Vascular Neurology
• Medical Devices

Background:

• Mechanical thrombectomy is effective for acute ischemic stroke, but technique optimization is needed.
• A Direct Aspiration First Pass Technique (ADAPT) is a key revascularization strategy.
• Evaluating factors influencing ADAPT success is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the impact of guide catheter position on revascularization rates.
• To determine the effect of microguidewire clot crossing on thrombectomy outcomes.
• To analyze factors influencing first-pass effect (FPE) in ADAPT.

Main Methods:

• Analysis of data from the Spanish ADAPT Registry on ACE catheters (SARA) (Jan 2018-Aug 2019).
• Inclusion of 589 patients undergoing mechanical thrombectomy for acute ischemic stroke.
• Subgroup analyses of guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores.

Main Results:

• Distal petrocavernous guide catheter placement was associated with higher odds of achieving FPE (aOR, 0.587).
• Avoiding microguidewire crossing of the clot increased the likelihood of FPE (aOR, 0.592) and complete reperfusion (aOR, 0.465).
• No significant difference in reperfusion time was observed across study groups; 90-day functional independence was 65.8%.

Conclusions:

• Petrocavernous guide catheter positioning enhances first-pass revascularization in ADAPT.
• Microguidewire use beyond the occlusion may decrease the likelihood of successful reperfusion.
• These findings offer guidance for optimizing ADAPT technique to improve stroke treatment outcomes.