Impact of the position of the aspiration catheter to the first pass effect during the combined technique

Abstract

The first pass effect, defined as achieving a complete recanalization with a single thrombectomy procedure, was recently established as a critical procedural performance metric for mechanical thrombectomy. Therefore, the purpose of this study was to evaluate whether the rate of the first pass effect improved when capturing the proximal end of the thrombus by aspiration catheter (CAPTAC) was achieved in mechanical thrombectomy using combined techniques. A prospectively-maintained acute stroke database was used to perform a retrospective review of patients who matched our eligibility criteria of (1) acute cardioembolic stroke, (2) middle cerebral artery (M1, M2) occlusions, and (3) treated with combined techniques as the first-pass procedure. The primary endpoint was the first pass effect. Eighty-one cases were included in the final analysis. CAPTAC was achieved in 42 cases (52%). The first pass effect was achieved more frequently in the CAPTAC group compared with the non-CAPTAC group (52% vs 18%, respectively; P = 0.001). CAPTAC was significantly higher during the period when new generation aspiration catheters were used (67% vs 43%, respectively; P = 0.04). CAPTAC was an independent predictor of achieving the first pass effect (odds ratio, 5.0; 95% confidence interval, 1.8-14; P = 0.001). Achievement of CAPTAC in combined techniques was associated with a significant improvement in the rate of the first pass effect. The use of the newer generation aspiration catheters may contribute to more effect treatment in combined techniques.

Keywords: Aspiration catheter; Combined technique; First pass effect; Mechanical thrombectomy; Thrombus engagement.