Procedural and Clinical Outcome Analysis of Monoplane versus Biplane Angiography Suites in Stroke Thrombectomies.

INTRODUCTION: Thrombectomy is now the standard of care in the treatment of acute ischemic stroke caused by emergent large vessel occlusion. Therefore, thrombectomy services have expanded from Comprehensive Stroke Centers (CSCs) to Thrombectomy-Capable Stroke Centers (TSCs). Stroke interventions at these sites are performed in both biplane and monoplane angiography suites. It has been hypothesized that differences in these systems may affect time to successful reperfusion, with a potentially significant effect on neurological outcomes. With an increase in TSCs, this study aims to evaluate the safety and efficacy of monoplane thrombectomy versus biplane thrombectomy.

METHODS: Patients who presented with isolated proximal middle cerebral artery (MCA) M1 occlusions and underwent endovascular thrombectomy from March 2015 to August 2018 at five different centers within a single health system were included. Thrombectomy was performed by the same group of experienced neurointerventionalists. The primary endpoint was functional outcome as measured by the modified Rankin scale at 90 days. Secondary endpoints included recanalization grade as measured by the Thrombolysis in Cerebral Infarction (TICI) score, time to final reperfusion and incidence of hemorrhagic conversion.

RESULTS: A total of 197 patients were included in this study. Of them, 80.7% underwent thrombectomy on biplane systems. Time to final reperfusion was 10.2 minutes longer in the monoplane group but was not statistically significant (p=0.252). There was no significant difference in the rates of favorable reperfusion (p=0.755), hemorrhagic conversion (p=0.580), or functional outcome at 90 days (Favorable mRS 0-2, p=0.210; favorable mRS 0-3, p=0.697).

CONCLUSION: Despite perceived advantages of biplane systems in reducing procedural time, our study demonstrates no significant differences between systems. This data not only supports the safety and efficacy of performing thrombectomy on monoplane systems, but also may carry implications for reducing patient transfer times and potentially increasing thrombectomy access to areas of the world where biplane suites may not be available. The next step would be a prospective randomized trial comparing both systems in different settings.