The first-pass effect (FPE) refers to the complete or near-complete revascularization with a single pass of mechanical thrombectomy devices. While previous claims suggest a link between larger catheters and the effectiveness of contact aspiration (CA) thrombectomy, no extensive research has confirmed if larger distal inner diameter (ID) catheters achieve higher FPE rates.
Methods
We searched PubMed, Scopus, and Web of Science to assess the impact of aspiration catheter distal ID size on FPE. The primary outcome was FPE rate, defined as thrombolysis in cerebral ischemia (TICI) grades 2c-3 at first pass, and the secondary outcome was modified FPE (TICI 2b-3 in a single pass). Aspiration catheters were categorized based on distal ID: 0.060–0.069 (medium bore), 0.070–0.074 (large bore), and greater than 0.074 inches (super-large bore). Rates of FPE were pooled using random effect models and compared using a Chi-square test.
Results
Our study included 34 articles with 4831 patients. FPE rates were 27.7% (95% CI, 15.1–45.3) for medium bore, 46.6% (95% CI, 33.7–59.9) for large, and 58.3% (95% CI, 44.8–70.7) for super-large catheters. The FPE rate was significantly higher for super-large bore catheters compared with other groups (χ² = 7.26, p = 0.03). A similar trend was observed for modified FPE rates, which were 51.1% (95% CI, 45.3–56.8) for medium bore, 60.0% (95% CI, 52.8–66.8) for large bore, and 80% (95% CI, 56.3–94.2) for super-large bore catheters (χ² = 8.14, p = 0.03).
Conclusion
Our analysis indicates that larger CA catheters are correlated with higher FPE rates.
GoyalMMenonBKvan ZwamWH, et al.Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet2016; 387: 1723–1731.
2.
HwangYHKangDHKimYW, et al.Impact of time-to-reperfusion on outcome in patients with poor collaterals. Am J Neuroradiol2015; 36: 495–500.
3.
AbbasiMLiuYFitzgeraldS, et al.Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes. J Neurointerv Surg2021; 13: 212–216.
4.
JangKMChoiHHNamTK,et al.Clinical outcomes of first-pass effect after mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis. Clin Neurol Neurosurg2021; 211: 107030.
5.
Arturo LarcoJAbbasiMLiuY, et al.Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: systematic review and meta-analysis. Interv Neuroradiol2022; 28: 358–363.
6.
TurkASSpiottaAFreiD, et al.Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg2014; 6: 231–237.
7.
TurkAS3rdSiddiquiAFifiJT, et al.Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet (London, England)2019; 393: 998–1008.
8.
Delgado AlmandozJEKayanYWallaceAN, et al.Larger ACE 68 aspiration catheter increases first-pass efficacy of ADAPT technique. J Neurointerv Surg2019; 11: 141–146.
9.
GrossBAHudsonJSTonettiDA, et al.Bigger is still better: a step forward in reperfusion with react 71. Neurosurgery2021; 88: 758–762.
10.
AlawiehAChatterjeeARVargasJ, et al.Lessons learned over more than 500 stroke thrombectomies using ADAPT with increasing aspiration catheter size. Neurosurgery2020; 86: 61–70.
11.
SchartzDEllensNKohliGS, et al.Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy. J Neurointerv Surg2023; 15: e111–e116.
12.
DoliaJNMohammadenMHTarekMA, et al.Structural analysis of aspiration catheters and procedural outcomes: an analysis of the SVIN registry. Stroke Vasc Interv Neurol2024; 4: e001214.
13.
RileyRDMoonsKGSnellKI, et al.A guide to systematic review and meta-analysis of prognostic factor studies. Br Med J2019; 364: k4597.
14.
LinLChuH. Meta-analysis of proportions using generalized linear mixed models. Epidemiology2020; 31: 713–717.
15.
AnadaniMAlawiehAVargasJ, et al.First attempt recanalization with ADAPT: rate, predictors, and outcome. J Neurointerv Surg2019; 11: 641–645.
16.
BrinjikjiWRazEDe LeacyR, et al.MRS SOFIA: a multicenter retrospective study for use of Sofia for revascularization of acute ischemic stroke. J Neurointerv Surg2022; 14: neurintsurg-2020–017042.
17.
ChivotCRenierJDeramondH, et al.Direct aspiration for thrombectomy in ischemic stroke: impact of dwell time. Interv Neuroradiol2020; 26: 211–215.
18.
FanHLiZLiY, et al.Comparison of a direct aspiration first pass technique vs. stent retriever thrombectomy for the treatment of acute large vessel occlusion stroke in the anterior circulation with atrial fibrillation. Front Neurol2023; 14: 1138993.
19.
GrossBAJadhavAPJovinTG,et al.Clinical comparison of new generation 0.071-inch and 0.072-inch aspiration catheters. World Neurosurg2019; 130: e463–e466.
20.
KaiserDLaskeKWinzerR, et al.Impact of thrombus surface on first pass reperfusion in contact aspiration and stent retriever thrombectomy. J Neurointerv Surg2021; 13: 221–225.
21.
MassariFDabusGCortezGM, et al.Super large-bore ingestion of clot (SLIC) leads to high first pass effect in thrombectomy for large vessel occlusion. J Neurointerv Surg2023; 15: 664–668.
22.
RaymondSBNasir-MoinMKochMJ, et al.Initial experience with react 68 aspiration catheter. Interv Neuroradiol2020; 26: 358–363.
23.
SchrammPNaviaPPapaR, et al.ADAPT technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: results from the PROMISE study. J Neurointerv Surg2019; 11: 226–231.
24.
SettecaseFKimWTSivapathamT, et al.Improved catheter delivery for aspiration thrombectomy using Tenzing 7 ledge reducing catheter and FreeClimb 70. Interv Neuroradiol2023; 28: 15910199231177754.
25.
TonettiDADesaiSMCasilloS, et al.Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy. J Neurointerv Surg2019; 11: 637–640.
26.
TsujiYYoshidaTShimizuF, et al.Clinical result of mechanical thrombectomy using Sofia plus with acute ischemic stroke compared with the stent retriever. World Neurosurg2021; 149: e11–e15.
27.
AmirehAOKuybuOAdeebN, et al.Utilization of the large-bore penumbra jet 7 reperfusion catheter in thrombectomy for acute ischemic stroke: a single-center experience. Interv Neuroradiol2021; 27: 99–106.
28.
AresWJChowdhrySTonettiDA, et al.Aristotle-only direct aspiration first-pass technique (AO-ADAPT) for endovascular mechanical thrombectomy: a technical series of a novel technique demonstrating safety and efficacy. Stroke Vasc Interv Neurol2024; 4: e001069.
29.
BologniniFLebedinskyPAMusacchioM, et al.SOFIA catheter for direct aspiration of large vessel occlusion stroke: a single-center cohort and meta-analysis. Interv Neuroradiol2021; 27: 850–857.
30.
BretznerMEstradeLFerrignoM, et al.Endovascular stroke therapy with a novel 6-French aspiration catheter. Cardiovasc Intervent Radiol2019; 42: 110–115.
31.
CaldwellJMcGuinnessBLeeSS, et al.Aspiration thrombectomy using a novel 088 catheter and specialized delivery catheter. J Neurointerv Surg2022; 14: 1239–1243.
32.
ChauYArnoffiPSuissaL, et al.Use of the rocket technique after failure of the direct aspiration first-pass technique in acute stroke thrombectomy. J Vasc Interv Radiol2022; 33: 572–577.e1.
33.
ChenFBaiXHuW, et al.A prospective, multicenter, single-group target-value clinical trial to evaluate the safety and efficacy of a large bore aspiration catheter system for the endovascular treatment of acute ischemic stroke. Front Neurol2022; 13: 864563.
34.
De MariniPNayakSZhuF, et al.A direct aspiration first pass technique with the new arc catheter for thrombectomy of large vessel occlusion strokes: a multicenter study. Interv Neuroradiol2019; 25: 187–193.
35.
DianaFVinciSLRuggieroM, et al.Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience. J Neurointerv Surg2022; 14: 666–671.
36.
LeoneGMutoMGiordanoF, et al.Initial experience using the new pHLO 0.072-inch large-bore catheter for direct aspiration thrombectomy in acute ischemic stroke. Neurointervention2023; 18: 30–37.
37.
LeylaRIsilAKAhmetG, et al.The predictors of prognosis in endovascular treatment of basilar artery occlusion. Neurol Asia2023; 28: 273.
38.
RohHKJuMWByounHS, et al.Forced suction thrombectomy in patients with acute ischemic stroke using the SOFIA plus device. J Cerebrovasc Endovasc Neurosurg2022; 24: 241–248.
39.
RomanoDGFrauenfelderGDianaF,et al.Technical note and first results on JET 7 thromboaspiration device for T-ICA occlusions. BMC Neurol2022; 22: 258.
40.
VargasJMajidiSHawkH, et al.Factors associated with improved technical outcomes when using 0.068-to 0.074-inch aspiration catheters: analysis from a multicenter retrospective cohort. Stroke Vasc Interv Neurol2023; 3: e000580.
41.
WaqasMLiWPatelTR, et al.Clot imaging characteristics predict first pass effect of aspiration—first approach to thrombectomy. Interv Neuroradiol2022; 28: 152–159.
42.
FredricksonVLBonneyPARangwalaSD, et al.Comparison of aspiration-first versus stentriever-first techniques in performing mechanical thrombectomy for large vessel occlusions. J Neurointerv Surg2021; 13: 614–618.
43.
SemeraroVValenteITrombatoreP, et al.Comparison between three commonly used large-bore aspiration catheters in terms of successful recanalization and first-passage effect. J Stroke Cerebrovasc Dis2021; 30: 105566.
44.
MöhlenbruchMAKabbaschCKowollA, et al.Multicenter experience with the new SOFIA plus catheter as a primary local aspiration catheter for acute stroke thrombectomy. J Neurointerv Surg2017; 9: 1223–1227.
45.
BoisseauWEscalardSFahedR, et al.Direct aspiration stroke thrombectomy: a comprehensive review. J Neurointerv Surg2020; 12: 1099–1106.
46.
NogueiraRGMohammadenMHAl-BayatiAR, et al.Preliminary experience with 088 large bore intracranial catheters during stroke thrombectomy. Interv Neuroradiol2021; 27: 427–433.
47.
Di MariaFKyhengMConsoliA, et al.Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: results from a multicentric prospective registry. Int J Stroke2021; 16: 20–28.
48.
HuoXSunDNguyenTN, et al.First-pass effect of mechanical thrombectomy for anterior circulation large vessel occlusion: incidence, predictors, and clinical impact. Insight from the ANGEL-ACT Registry. J Neurosurg2023; 139: 670–677.
49.
ZhengHZhaiYCaoW, et al.First pass effect in patients undergoing endovascular treatment for posterior circulation acute ischemic stroke. J Stroke Cerebrovasc Dis2024; 33: 107640.
50.
Al KasabSAlmallouhiEAlawiehA, et al.Impact of increasing aspiration catheter size and refinement of technique: experience of over 1000 strokes treated with ADAPT. Neurosurgery2022; 91: 80–86.
51.
YaegerKIsersonASinghP, et al.A technical comparison of thrombectomy vacuum aspiration systems. J Neurointerv Surg2020; 12: 72–76.
52.
ReymondPBrinaOGirdharG, et al.Experimental evaluation of the performance of large bore aspiration catheters. J Neuroradiol2023; 50: 74–78.
53.
LiuYGebrezgiabhierDZhengY, et al.Arterial collapse during thrombectomy for stroke: clinical evidence and experimental findings in human brains and in vivo models. Am J Neuroradiol2022; 43: 251–257.
54.
CharbonnierGPrimikirisPDesmaretsM, et al.Defining the optimal size of an aspiration catheter in relation to the arterial diameter during mechanical thrombectomy for stroke. J Neuroradiol2024; 51: 47–51.
55.
GhaithAKEl NaamaniKMualemW, et al.Transradial versus transfemoral approaches in diagnostic and therapeutic neuroendovascular interventions: a meta-analysis of current literature. World Neurosurg2022; 164: e694–e705.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
