Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

Abstract

BackgroundDirect aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood.MethodsA systematic literature review and meta-regression analysis was completed to evaluate the impact of primary aspiration thrombectomy outcomes based on the ID of the aspiration catheter. Primary outcome measures were: final recanalization of modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3 with aspiration only and with rescue modalities, first pass effect (FPE), need for rescue modalities, intracranial hemorrhagic complication rates, and functional outcomes of 90-day modified Rankin Scale (mRS) of 0–2.Results30 studies were identified with 3228 patients. Meta-regression analysis revealed a significant association between increasing aspiration catheter ID and FPE (p=0.032), between ID and final recanalization with aspiration only (p=0.05), and between ID size and recanalization including cases with rescue modalities (p=0.002). Further, subgroup analysis indicated that catheters with an ID ≥0.064 inch had a lower rate of need for rescue than smaller catheters (p=0.013). Additionally, catheters with an ID ≥0.068 inch had a higher rate of intracranial bleeding complications (p=0.025). Lastly, no significant association was found in functional outcomes overall.ConclusionsLarger aspiration catheters are associated with a higher rate of FPE, final recanalization with only an aspiration catheter, and in cases with rescue modalities, though with a higher rate of hemorrhagic complications. These findings confirm that aspiration catheter size functions as a variable in aspiration thrombectomy, which should be considered in future study and trial design.

Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study

“…The evolution of EVT devices, including the use of BGC and more complex SR designs, certainly led to improved recanalization rates, but it appears that it was principally the use of larger diameter aspiration catheters that drove the improvement of recanalization results during the study period. 38 Based on a description of EVT outcomes in a large multicenter national registry, our study provides reliable and detailed endpoints for EVT result assessments over time. Indeed, efforts should focus on the rate of FPE for which there is still room for improvement.…”

“…The evolution of EVT devices, including the use of BGC and more complex SR designs, certainly led to improved recanalization rates, but it appears that it was principally the use of larger diameter aspiration catheters that drove the improvement of recanalization results during the study period. 38…”

Technique and impact on first pass effect primary results of the ASSIST global registry

“…Moreover, the authors found a higher rate of symptomatic hemorrhages with larger bore catheters. 21 Patients enrolled in the DA arm of the ASSIST Registry did not have a significant difference in first pass reperfusion with larger bore catheters compared with smaller bore catheters.…”