Introduction: Direct aspiration is a thrombectomy technique that has been shown to be fast and effective. Our aim is to determine whether aspiration is superior to stentriever in procedure times and outcomes.
Methods: We performed a retrospective analysis on 93 stroke patients who received endovascular treatment for acute stroke at four hospitals in Manhattan. Baseline characteristics, procedures times, success at achieving TICI 2b/3, and change in NIHSS from admission to discharge were compared between patients treated with aspiration only (N=34), stentriever only (N=43), or both aspiration and stentriever (N=16).
Results: Mean puncture-to-recanalization time was 31.3 minutes for direct aspiration and 50.6 minutes for stentriever (P<0.0001). Mean change in NIHSS was -9.0 in the aspiration group and -0.1 in the stentriever group (P=0.0045). Onset-to-puncture times were shorter for the aspiration-only group compared to stentreiver, however, a generalized linear model suggests change in NIHSS is more driven by procedure method (P=0.0373) over onset-to-puncture time (P=0.1813). There was no significant difference in admission NIHSS, IV tPA administration, number of passes, and TICI score between aspiration only and stentriever groups. There was no significant difference in puncture-to-recanalization time and change in NIHSS between stentriever and ADAPT (a direct aspiration first pass technique) with subsequent stentriever.
Conclusions: Patients who received direct aspiration thrombectomy had faster recanalization times and superior improvement in NIHSS compared to patients treated with stentriever. A limitation is that this is a retrospective study and patients were not randomized to treatment. These results should be verified in a larger prospective study.
Patient Care: This research compares thrombectomy methods and suggests direct aspiration is an effective technique for ischemic stroke.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of direct aspiration in the treatment of ischemic stroke, 2) Discuss, in small groups, advantages of the aspiration versus stentriever technique, 3) Identify an effective treatment for thrombectomy.