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Comparison of 4 mm-sized and 3 mm-sized Stent Retrievers in Mechanical Thrombectomy for M2 Occlusion
Han Gyul Lee1, Ho Jun Yi1,2,3, Dong-Seong Shin2
1Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Introduction:
A stent retriever (SR) is widely used in mechanical thrombectomy (MT) for M2 segment occlusion. However, the suitable size of SR in M2 occlusion remains unclear. Therefore, we aimed to compare 4 mm-sized SR with 3 mm-sized SR in M2 occlusion.
Methods:
Patients who underwent MT with SR for M2 occlusion were dichotomized into 4×20 mm SR and 3×20 mm SR groups. Then, 1:1 propensity score matching was performed. The M2 segment was divided into proximal and distal segments according to the occlusion site. Subgroup analysis was then performed for each cohort.
Results:
A total of 111 patients were enrolled, with 4×20 mm SR and 3×20 mm SR applied in 72 (64.9%) and 39 (35.1%) cases, respectively. In propensity score matching, mean number of stent passages for reperfusion was significantly lower in the 4×20 mm SR group than in the 3×20 mm SR group (1.5 ± 0.8 vs. 2.1 ± 1.1; p = 0.004). First-pass reperfusion (FPR) was more highly achieved in the 4×20 mm SR group than in the 3×20 mm SR group (52.6% vs. 42.1%; p = 0.007). In both proximal and distal occlusion cohorts, the 4 mm SR group showed lower mean number of SR passage (p = 0.004 and p = 0.003, respectively) and higher FPR rate than the 3 mm SR group (p = 0.003 and p = 0.007, respectively).
Conclusion:
In MT for M2 occlusion, 4×20 mm SR enables an effective procedure with lesser SR passage for reperfusion and a higher rate of FPR than 3×20 mm SR.
Insights
A 4 mm stent retriever (SR) is more effective for mechanical thrombectomy (MT) in M2 segment occlusions than a 3 mm SR. The larger SR requires fewer passages for reperfusion and achieves a higher first-pass reperfusion rate.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Medical Devices
Background:
- Mechanical thrombectomy (MT) utilizes stent retrievers (SR) for M2 segment occlusions.
- Optimal SR sizing for M2 occlusions remains an area of investigation.
Purpose of the Study:
- To compare the efficacy of 4 mm SR versus 3 mm SR in MT for M2 occlusions.
- To evaluate procedural outcomes based on SR size.
Main Methods:
- Retrospective analysis of 111 patients undergoing MT for M2 occlusion.
- Dichotomization into 4×20 mm SR and 3×20 mm SR groups.
- 1:1 propensity score matching and subgroup analysis for proximal and distal M2 occlusions.
Main Results:
- The 4 mm SR group required significantly fewer stent passages for reperfusion (1.5 vs. 2.1; p=0.004).
- First-pass reperfusion (FPR) rates were significantly higher with 4 mm SR (52.6% vs. 42.1%; p=0.007).
- These benefits were consistent in both proximal and distal M2 occlusion subgroups.
Conclusions:
- The 4×20 mm SR is more effective than the 3×20 mm SR for M2 occlusions.
- Utilizing a 4 mm SR leads to a more efficient procedure with improved reperfusion outcomes.
