Abstract WMP8: Efficacy Of Combined Use Of Stent Retriever And Aspiration Catheter In Mechanical Thrombectomy For Acute Ischemic Stroke

Background and Purpose: Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) using a stent retriever (SR) or contact aspiration (CA) has been established as standard therapy. The efficacy of combined use of an SR and aspiration catheter (combined technique: CBT) to achieve successful recanalization has not been fully elucidated. Here, we investigated the safety and efficacy of CBT compared with MT with the single use of an SR or CA. Methods: We analyzed 763 consecutive patients who underwent MT for AIS in the anterior circulation between January 2013 and January 2020 at six comprehensive stroke centers. The patients were divided into two groups based on the technique in the first attempt for thrombus removal: the CBT group and single device (SR/CA) group. The rate of successful recanalization with first pass (SRFP), the rate of final successful recanalization, and other procedural outcomes were compared between the groups. Results: A total of 571 patients (CBT group, 270; SR/CA group, 301 [SR: 128, CA: 173]), were analyzed. The rate of SRFP (mTICI 2c-3, 41.1 % vs. 27.9 %; p = 0.001; mTICI 3, 34.0 % vs. 25.5 %; p = 0.027) and final mTICI 2b-3 recanalization (88.8 % vs. 82.0 %; p = 0.024) was significantly higher, puncture to reperfusion time was shorter (median [IQR], 43 [31.2-69] vs. 55 (38-82.2) min; p = 0.004) and the number of passes were fewer (mean ± SD, 1.74 ± 0.93 vs. 1.99 ± 1.01; p = 0.002) in the CBT group compared with the SR/CA group. Procedural complications did not differ between the two groups. Subgroup analysis revealed that CBT was more effective for women, patients with cardioembolic stroke, internal carotid artery, and M2 occlusion. Conclusions: CBT could increase the rate of SRFP and shorten the puncture to reperfusion time without increasing procedural complications.