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.

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.