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Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique

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Stroke & Vascular Neurology 2021年第4期6卷 553-560页

作者： Carlos Pérez-García christian maegerlein Santiago Rosati Charlotte Rüther Carlos Gómez-Escalonilla Claus Zimmer Juan Arrazola Maria Teresa Berndt Manuel Moreu Interventional Neuroradiology Hospital Clinico Universitario San CarlosMadridSpain Department of Diagnostic and Interventional Neuroradiology Klinikum rechts der Isar der Technischen Universitat MunchenMunchenBayernGermany Neurology Hospital Clinico Universitario San CarlosMadridSpain Radiology Hospital Clinico Universitario San CarlosMadridSpain

Background and purpose The first-pass effect(FPE),defined as a first-pass Expanded Treatment in Cerebral Ischaemia(eTICI)2c/3 reperfusion,has emerged as a key metric of efficacy in mechanical thrombectomy(MT)for acute ischaemic stroke.The proximal balloon occlusion together with direct thrombus aspiration during stent retriever thrombectomy(PROTECT)-PLUS technique consists in the use of a balloon guide catheter and a combined MT approach involving contact aspiration and a stent retriever.The aim of this study is to assess the effectiveness and safety of the PROTECT-PLUS technique using distal aspiration catheters(DACs)with different inner diameters by comparing the large-bore DAC Catalyst 7 versus the use of medium-bore DACs.Methods Retrospective analysis of a prospectively maintained database of patients treated with PROTECT-PLUS using Catalyst 7,Catalyst 6 or Catalyst 5 with an occlusion of either the terminal carotid artery or the M1 or M2 segments of the middle cerebral artery from 2018 to 2020 in two comprehensive stroke centres.Baseline characteristics and procedural,safety and clinical outcomes were compared between groups.Multivariable logistic regression analysis was performed in order to find independent predictors of FPE.Results We identified 238 consecutive patients treated with PROTECT-PLUS as front-line approach using Catalyst 7(n=86),Catalyst 6(n=78)and Catalyst 5(n=76).The rate of FPE was higher with Catalyst 7(54%)than Catalyst 6(33%,p=0.009)and Catalyst 5(32%,p=0.005),in addition to higher final eTICI 2c/3 reperfusion rates,shorter procedural times,lower need of rescue therapy and fewer procedure-related complications.After multivariable analysis the sole independent factor associated to FPE was the use of Catalyst 7(OR 2.34;95%CI 1.19 to 4.58;p=0.014).Conclusion Further development of combined MT by incorporating larger-bore aspiration catheters is associated with higher reperfusion rates,shorter procedure times,and lower need of rescue therapy while reducing the complication rates.

关键词： shorter effect maintained

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