Clinical comparison of aspiration to stentriever-mediated aspiration thrombectomy for M2 occlusions

While revascularization for M2 occlusions is generally recommended and considered beneficial, the optimal approach (aspiration vs stentriever/combined) is less well defined in the literature. We sought to compare outcomes after thrombectomy with manual aspiration thrombectomy alone (MAT) or stentriever-mediated aspiration thrombectomy (SMAT) MATERIALS AND METHODS: To circumvent inter-operator technical variability, patients underwent thrombectomy for M2 occlusions by a single operator and were stratified by first pass approach: manual aspiration thrombectomy (MAT/aspiration alone) and stentriever-mediated manual aspiration thrombectomy (SMAT/combination). Efficacy outcomes included good reperfusion (mTICI score ≥2b) and a favorable 90-day functional outcome (mRS score of ≤2). Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage.

One hundred three patients were identified: 57 underwent MAT whereas 46 underwent SMAT. Good reperfusion (TICI 2b or greater) was comparable between groups (93.5 % vs. 87.7 %, P=0.33). The intracranial hemorrhage rate was higher with SMAT compared to MAT (13 % vs. 1.8 %, P=0.04). Puncture-to-recanalization time was longer in SMAT (34.4 vs. 19.9 minutes, P<0.001). In multivariable analysis, complete or good reperfusion was associated with shorter puncture-recanalization time (adjusted odds ratio [aOR], 0.85) or less total passes (aOR, 0.58), respectively. In a propensity score matched analysis of 66 patients with comparable baseline and technical efficiency, the safety outcomes were not different between SMAT and MAT groups.

SMAT compared with MAT did not result in an improved revascularization rate or functional outcome, while it was related to more hemorrhagic complications and mortality. Given cost and time savings with manual aspiration alone, this approach may be optimal as first line for M2 occlusions.