Superlarge-Bore Versus Large-Bore Aspiration Catheters in Mechanical Thrombectomy: A Multicenter Propensity-Matched Analysis.

Abstract

Aspiration catheters are an integral component of mechanical thrombectomy for acute ischemic stroke (AIS). Following early series demonstrating increasing procedural efficiency and improved outcomes with use of large-bore (LB) aspiration catheters, there is increased interest in the use of emerging superlarge-bore (SLB) catheters. We retrospectively analyzed AIS patients with large vessel occlusion treated at 34 international centers (2018-2025) using SLB or LB aspiration catheters on the first attempt. We used propensity score matching (1:6) to define a balanced cohort based on baseline and technical confounders between the catheter groups. Safety, efficacy, and technical outcomes were compared, with the primary outcome being the first pass effect (FPE). A total of 2032 patients treated with aspiration as the frontline technique were included (SLB n = 107; LB n = 1925). After propensity score matching (SLB n = 107; LB n = 642), there was no significant difference in FPE between the SLB and LB groups (56.1% vs 54.8%; odds ratio [OR] 1.05, P = .8). Secondary efficacy outcomes were similarly comparable, including functional independence at 90 days (50.0% vs 46.9%; OR 1.13, P = .586), successful recanalization (modified thrombolysis in cerebral infarction ≥2b) (96.3% vs 93.5%; OR 1.78, P = .3), and median time to modified thrombolysis in cerebral infarction ≥2b (22.0 vs 22.8 minutes; β = -5.94, P = .7). Safety outcomes were also comparable, including intraprocedural complications (10.3% vs 8.2%, P = .5), symptomatic intracranial hemorrhage (8.7% vs 6.6%, P = .4), embolization to new territory (15.9% vs 13.1%, P = .4), and 90-day mortality (21.6% vs 27.1%, P = .3). Using a 10% noninferiority margin, LB aspiration catheters met the prespecified noninferiority criterion compared with SLB aspiration catheters for successful recanalization and FPE. Our findings remained consistent in the subgroup restricted to internal carotid artery and M1 occlusions. The use of SLB aspiration catheters showed comparable safety and efficacy with standard LB catheters for mechanical thrombectomy in AIS.