Effects of Intermediate Catheter Evolution on Technical Outcome of Mechanical Thrombectomy-A Comparison of the Performance of Two Distal Access Catheters in Mechanical Thrombectomy of Acute Ischemic Stroke.

Abstract

Fast and secure access to intracranial vessel occlusion is essential for mechanical thrombectomy (MT) in the treatment of acute ischemic stroke. We compared 2 intermediate distal access catheters (DAC: Distal Access Catheter [C1] and SOFIA: Soft torquable catheter Optimized For Intracranial Access [C2]) for procedural speed and safety of MT as well as clinical outcome at discharge and after 90 days. This is a retrospective study of all 398 consecutive patients receiving MT with C1 or C2 for the treatment of acute ischemic stroke between September 2010 and June 2016, using a propensity score matched cohort. Baseline characteristics, clinical outcome, and procedural factors such as the number of retrieval attempts or duration of procedure were analyzed. A total of 282 patients (70.9%) underwent MT with C1 and 116 patients (29.1%) with C2. MT with C2 was faster with an average duration of 69.8 ± 51 minutes (mean ± standard deviation) compared with 80.6 ± 54 minutes with C1 (P < 0.05). The average number of necessary stent-retriever maneuvers was significantly lower with C2 (1.8 ± 1.7 vs. 3.2 ± 2.5, P < 0.0001). Successful MT with aspiration only yielded higher modified Thrombolysis in Cerebral Infarction rates (mTIC 2b/3 69.9% vs. 31.5%, P < 0.0001) with C2. Modified Rankin Scale at discharge was significantly lower with C2 (3.5 ± 1.9) versus C1 (3.9 ± 1.7, P < 0.05). No significant differences of modified Rankin Scale 90 were observed. The use of C2 resulted in reduced procedural times with less stent-retriever maneuvers. Clinical outcome at discharge was better for C2 catheters, whereas no significant difference of outcome was apparent after 90 days.