A total of 127 consecutive patients with intracranial anterior circulation vessel occlusion underwent thrombectomy by an intention to treat using the aspiration first technique from September 2017 to September 2018.
This group was compared to 127 consecutive thrombectomies performed between April 2016 and May 2017 who were primarily treated with stent-retriever method.
On analysis of aspiration used as the first technique,
there were a total of 91 aspiration cases and 163 stent-retriever first techniques.
The baseline demographics,
NIHSS,
those undergoing thrombolysis and Thrombolysis in Cerebral Infarction (TICI) score are evaluated in Table 1.
There was no significant difference in age,
NIHSS and those undergoing thrombolysis between the two groups.
In terms of vessel occlusion,
there were more M2 occlusions in the stent-retriever cohort,
however this was not statistically significant.
Table 1: Baseline Characteristics
The aspiration-first technique had a median length of time from groin punctures to 1st angiogram of 6 minutes,
versus 5 minutes in the stent-retriever group (p=0.234).
The aspiration-first technique had a shorter median length from first angiogram to first reperfusion of 11 mins versus 19.5 mins in the stent-retriever group,
(p <0.001).
Similarly of the 91 cases where aspiration was in fact used first,
the median time from first angiogram to reperfusion compared with the stent-retriever group was 8 minutes versus 17 minutes (p<0.001).
The aspiration first cohort had a shorter median time from groin puncture to first reperfusion compared to the stent-retriever group in the intention to treat group (18 minutes versus 26 minutes,
p<0.001) and when aspiration was in fact the first device used (17 minutes versus 25 minutes,
p<0.001).
The aspiration-first technique had a shorter median overall duration of procedure of 26 minutes versus 47 minutes in the stent-retriever group (p<0.001).
On analysis of the actual aspiration-first technique (n=91),
the median overall length of the procedure was 21 minutes compared to 41 minutes for the stent-retriever only group (p<0.001).
Table 2: Time Variables Aspiration versus Stent-retriever (Intention to treat)
Table 3: Time Variables Aspiration versus Stent-retriever (Actual device used)
The aspiration-first technique necessitated fewer passes (mean 2.4 vs 3.1,
p<0.05),
which aided in the lower duration of procedure.
Successful recanalisation (TICI 2b-3) was observed in 90.9% of patients overall.
96.1% had successful recanalisation (TICI 2b-3) in the aspiration first group compared to 85.8% in the stent-retriever group (p<0.005).
A higher proportion of patients had a TICI score of 2c-3 in the aspiration-first group compared to stent-retriever (78% vs 60.6%,
p<0.005).