Superlarge-Bore Versus Large-Bore Aspiration Catheters in Mechanical Thrombectomy: A Multicenter Propensity-Matched Analysis
Abstract
BACKGROUND AND OBJECTIVES: 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. METHODS: 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). RESULTS: 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. CONCLUSION: The use of SLB aspiration catheters showed comparable safety and efficacy with standard LB catheters for mechanical thrombectomy in AIS.
// Source
Authors: Ariana Chacón, Ali Alawieh, Mustafa Motiwala, Dareen Hijazi, Violiza Inoa, C. Michael Cawley, Brian M. Howard, Ansaar Rai, Fazeel Siddiqui, Ali Alaraj, Daniele G. Romano, David Fiorella, Ilko Maier, Justin Dye, Mohamad Ezzeldin, Stacey Quintero Wolfe, Justin Mascitelli, Isabel Fragata, Charles Matouk, Kaustubh Limaye, Christopher S. Ogilvy, Waleed Brinjikji, Pascal Jabbour, Eyad Almallouhi, Ergün Dağlıoğlu, Min Park, Pedro Navia, Ramesh Grandhi, David Altschul, Clemens Schirmer, A Paul, Maxim Mokin, Christopher Nickele, Hidetoshi Matsukawa, Kazutaka Uchida, Marios-Nikos Psychogios, Michael R. Levitt, Robert M. Starke, Alejandro M. Spiotta, Jonathan A. Grossberg, Nitin Goyal, on behalf of the STAR Collaborators
Institutions: University of Washington, Harvard University, Montefiore Medical Center, University of Basel, University of South Florida, Albert Einstein College of Medicine, Emory University, University of Iowa, Universitätsmedizin Göttingen, Yale University, University of Utah, Stony Brook University, University of Illinois Chicago, Sağlık Bilimleri Üniversitesi, University of Health Science, The University of Texas at San Antonio Health Science Center, Hospital Universitario La Paz, Beth Israel Deaconess Medical Center, West Virginia University, Mayo Clinic, Bilkent University, Medical University of South Carolina, Atrium Health Wake Forest Baptist, Loyola University Medical Center, Başkent University Hospital, Loma Linda University, The University of Texas Health Science Center at Houston, Thomas Jefferson University, University of Tennessee Health Science Center, Neurological Surgery, University of Iowa Health Care, University of Miami Health System, Hyogo University, AOU San Giovanni di Dio e Ruggi d'Aragona, Geisinger Health System, Metro Health Hospital, Albany Medical Center Hospital, Semmes Murphey Foundation, Unidade Local de Saúde de São José, Sarasota Memorial Hospital