Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

• Published in: Journal of neurointerventional surgery Vol. 15; no. e1; pp. e111 - e116
• Main Authors: Schartz, Derrek, Ellens, Nathaniel, Kohli, Gurkirat Singh, Rahmani, Redi, Akkipeddi, Sajal Medha K, Colby, Geoffrey P, Hui, Ferdinand, Bhalla, Tarun, Mattingly, Thomas, Bender, Matthew T
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.09.2023; BMJ Publishing Group LTD
• Subjects: Catheter; Catheters; Clinical outcomes; Device; Intervention; Ischemia; Ischemic stroke; Literature reviews; Regression analysis; Software; Stroke; Systematic review; Thrombectomy; Variables; Veins & arteries
• ISSN: 1759-8478; 1759-8486
• DOI: 10.1136/jnis-2022-019246

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.