Abstract WP38: Optimum Technique for Complete Revascularization After First Pass in Mechanical Thrombectomy

Background: The benefits of endovascular revascularization using the Aspiration vs Stent retriever vs Combined approach in patients with acute ischemic stroke remain uncertain due to lack of evidence from randomized controlled trials. The ASTER trial has shown that aspiration was as successful as stent retriever in revascularization rates in patients in with large vessel occlusion receiving EVT. However, there is a lack of studies that compared the combined approach with aspiration or stent alone. Methods: We retrospectively reviewed consecutive patients presenting with AIS with LVO from February 2016 to May 2019. Of the 157 patients, 101 patients who presented with LVO in M1 segment or ICA terminus occlusion were included in the study. Patients were divided based on the first pass EVT technique into Aspiration, Stent retriever and Combined (Aspiration+Stent) groups. The primary outcomes were 1st pass TICI 3 and 1st pass successful recanalization (TICI 2b or TICI 3). Secondary outcomes were number of passes in successful thrombectomies and TICI 2b rates after 1st pass. Results: A total of 101 patients with M1 and ICA terminus occlusion were included; female 56 (55.4%); male 45 (44.6%); mean age 67.84 years; of whom 32 (31.7%) have received aspiration, 20 (19.8%) stent, and 49 (48.5%) received both. This study showed that primary outcome 1st pass TICI 3 was 50% in aspiration group, 53.1% in combined group, and 30% in stent group with p value of 0.68. 1st pass successful recanalization (TICI 2b and TICI 3) results showed 60% in aspiration group, 55.1% in combined group, and 60% in stent group with p value 0.42. Number of passes in successful thrombectomies were 1.43, 1.54, and 1.59 mean in aspiration, combined and stent cohorts respectively. TICI 2b rates after 1st pass were 15.6%, 2%, and 25% in aspiration, combined and stent population with p value 0.21. Conclusion: In our cohort, both aspiration alone and combined (aspiration+stent retriever) were equally effective in achieving TICI 3 recanalization after first pass. Although the combined approach which is more expensive, has been widely used recently, there may be no additional benefit of this technique compared to aspiration. Randomized controlled studies are needed to further delineate results of different methods.