Comparison of Aspiration versus Stent Retriever Thrombectomy as the Preferred Strategy for Patients with Acute Terminal Internal Carotid Artery Occlusion: A Propensity Score Matching Analysis

Abstract

BACKGROUND AND PURPOSE: There is no consensus on endovascular treatment for terminal ICA. The purpose of this study was to evaluate the comparative safety and efficacy of preferred aspiration thrombectomy and stent retriever thrombectomy for revascularization in patients with isolated terminal ICA occlusion. MATERIALS AND METHODS: We conducted a retrospective analysis of patients with terminal ICA occlusion treated with aspiration thrombectomy or stent retriever thrombectomy in our center, from September 2013 to November 2018. To minimize the case bias, propensity score matching was performed. The primary outcomes were successful reperfusion defined by expanded TICI grades 2b-3 at the end of all endovascular procedures and puncture-to-reperfusion time. RESULTS: A total of 109 consecutive patients with terminal ICA occlusion were divided into the aspiration thrombectomy group (40 patients) and the stent retriever thrombectomy group (69 patients), and 30 patients were included in each group after propensity score matching. The proportion of complete reperfusion was significantly higher in the aspiration thrombectomy group (OR 4.75 [95% CI, 1.10-1.38]; P ¼ .002). The median puncture-to-reperfusion time in the aspiration thrombectomy group was shorter than that in the stent retriever thrombectomy group (38 versus 69 minutes; P ¼ .001). Fewer intracerebral hemorrhage events were recorded in the aspiration thrombectomy group (OR 0.29 [95% CI, 0.09-0.90]; P ¼ .028). No significant differences were observed for good outcomes (OR 1.92 [95% CI, 0.86-4.25]) and mortality (OR 0.84 [95% CI, 0.29-2.44]) at 90 days. CONCLUSIONS: For the treatment of terminal ICA occlusion, aspiration thrombectomy was technically superior to stent retriever thrombectomy in the absence of a balloon guide catheter in achieving successful reperfusion with shorter puncture-to-reperfusion time and procedure-related adverse events.

Comparing Endovascular Treatment Methods in Acute Ischemic Stroke Due to Tandem Occlusion Focusing on Clinical Aspects

“…In 2020, Xing et al directly investigated the two MT techniques efficacy in tICA occlusions. Patients treated with the direct aspiration technique achieved significantly higher successful recanalization rates which may explain the slightly better successful recanalization rate in our study compared to previous studies (83.6% vs. 78%) [19,25].…”

Clot Meniscus Sign Is Associated With Thrombus Permeability and Choice of Mechanical Thrombectomy Technique in Acute Middle Cerebral Artery Occlusion

“…Second, the CA procedure is started by advancing a guide catheter that contains an 8-or 9-Fr balloon guiding catheter (BGC) or 6-Fr neurosheath to the proximity of the occluded target vessel, while meniscus-like appearance provides a larger area for contact with the catheter (24). Choosing CA with proximal blood flow arrest by BGC can reduce the risk of ectopic distal thrombosis and increase the effect of flow reversal during aspiration (25)(26)(27).…”

Should the direct aspiration first pass technique be advocated over the stent-retriever technique for acute ischemic stroke? A systematic review and meta-analysis of 7692 patients

“…From these 351 studies, 30 studies were included in the meta-analysis. [ 2 - 5 , 7 , 9 - 10 , 12 , 14 - 22 , 24 - 28 , 30 , 32 , 33 , 36 - 38 , 40 , 41 ] The references of the included studies were manually searched, and no further articles were included. The flow chart of the study selection process is shown in the PRISMA flow diagram in [ Figure 1 ].…”