Abstract
PurposeMechanical thrombectomy using the stent-retriever in conjunction with the distal access catheter may improve the rates of successful revascularization and clinical outcomes in patients with acute stroke. We aimed to compare two different thrombectomy techniques, according to the position of the distal access catheter tip in the combined stent-retriever and aspiration approach.MethodsIn this retrospective study, patients with middle cerebral artery occlusion treated with the combined technique were divided into two groups based on the tip position of the distal access catheter: distal group (catheter placed adjacent to the thrombus) and proximal group (catheter placed in the cavernous segment of the internal carotid artery below the ophthalmic artery). Baseline characteristics, angiographic results, and clinical outcomes were compared.ResultsEighty-three patients (distal group, n = 45; proximal group, n = 38) were included. Higher complete reperfusion was observed in the distal group (unweighted analysis: 66.7% vs. 42.1%, p = 0.025; weighted analysis: 74.0% vs. 28.8%; p = 0.002). In the multivariate analysis, the distal tip position was independently associated with complete reperfusion (unweighted analysis: aOR, 4.10; 95% CI, 1.40–11.98; p = 0.01; weighted analysis: aOR, 5.20; 95% CI, 1.72–15.78; p = 0.004). The distal group also showed more favorable clinical outcomes and early neurological improvement (unweighted analysis: 62.2% vs. 55.3%; p = 0.521, 60% vs. 50%; p = 0.361, respectively; weighted analysis: 62.7% vs. 61.1%; p = 0.877, 66% vs. 45.7%; p = 0.062, respectively). However, more arterial dissections were observed in the distal group (8.9%, n = 4 vs. 2.6%, n = 1; p = 0.36). In the distal group, one patient with vascular injury died due to complications. No cases of emboli in new territory were observed.ConclusionsDistal tip position of the distal access catheter has a significant impact on reperfusion in patients with acute ischemic stroke. However, there was also a higher rate of vascular injury as the catheter was advanced further. If advancement to the target lesion is too difficult, placing it in the cavernous internal carotid artery may be a viable method without complications.
Highlights
With five large randomized clinical trials in 2015 demonstrating the superiority of endovascular treatment over medical treatment in acute ischemic stroke caused by large vessel occlusion [1,2,3,4,5], neurointerventionalists are striving to refine their approaches to increase revascularization rates using new devices and techniques
The distal tip position was independently associated with complete reperfusion
If advancement to the target lesion is too difficult, placing it in the cavernous internal carotid artery may be a viable method without complications
Summary
With five large randomized clinical trials in 2015 demonstrating the superiority of endovascular treatment over medical treatment in acute ischemic stroke caused by large vessel occlusion [1,2,3,4,5], neurointerventionalists are striving to refine their approaches to increase revascularization rates using new devices and techniques. Stent-retriever thrombectomy in conjunction with a distal access catheter (DAC), when compared with conventional thrombectomy (guide catheter with only stent-retriever), led to improved rates of revascularization and clinical outcomes [7]. The aspiration force and effect of the DAC in the combined stent-retriever and aspiration technique are expected to produce optimal results when the distance between the distal tip position of the DAC and the thrombus is short. The purpose of our study was to compare the actual effect of DAC tip positions on angiographic and clinical outcomes following thrombectomy using the combined stent-retriever and aspiration technique
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