Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy
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-r...
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Published in | Journal of neurointerventional surgery Vol. 15; no. e1; pp. e111 - e116 |
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01.09.2023
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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. |
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AbstractList | 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. Background Direct 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. Methods A 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. Results 30 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. Conclusions Larger 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. |
Author | Mattingly, Thomas Bender, Matthew T Akkipeddi, Sajal Medha K Bhalla, Tarun Rahmani, Redi Ellens, Nathaniel Colby, Geoffrey P Kohli, Gurkirat Singh Schartz, Derrek Hui, Ferdinand |
Author_xml | – sequence: 1 givenname: Derrek surname: Schartz fullname: Schartz, Derrek organization: Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA – sequence: 2 givenname: Nathaniel surname: Ellens fullname: Ellens, Nathaniel organization: Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 3 givenname: Gurkirat Singh surname: Kohli fullname: Kohli, Gurkirat Singh organization: Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 4 givenname: Redi surname: Rahmani fullname: Rahmani, Redi organization: Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 5 givenname: Sajal Medha K surname: Akkipeddi fullname: Akkipeddi, Sajal Medha K organization: Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 6 givenname: Geoffrey P surname: Colby fullname: Colby, Geoffrey P organization: Neurosurgery, University of California Los Angeles, Los Angeles, California, USA – sequence: 7 givenname: Ferdinand orcidid: 0000-0003-3759-7886 surname: Hui fullname: Hui, Ferdinand organization: Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA – sequence: 8 givenname: Tarun surname: Bhalla fullname: Bhalla, Tarun organization: Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 9 givenname: Thomas orcidid: 0000-0003-2949-5521 surname: Mattingly fullname: Mattingly, Thomas organization: Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA – sequence: 10 givenname: Matthew T orcidid: 0000-0002-5101-0431 surname: Bender fullname: Bender, Matthew T email: bender@urmc.rochester.edu organization: Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA |
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Snippet | BackgroundDirect aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration... Background Direct aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration... BACKGROUNDDirect aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration... |
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SubjectTerms | Catheter Catheters Clinical outcomes Device Intervention Ischemia Ischemic stroke Literature reviews Regression analysis Software Stroke Systematic review Thrombectomy Variables Veins & arteries |
Title | Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy |
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