Shorter procedures and less radiation with monopoint aspiration compared to conventional aspiration or stentriever-assisted aspiration for mechanical thrombectomy

Abstract

Introduction

Mechanical thrombectomy (MT) techniques affect procedure lengths and radiation exposure, with both reduced with contact aspiration (CA) compared to combination stentriever-assisted aspiration (SA). Monopoint MT has higher first pass effect (FPE) rates, less technical crossover, and recanalization with fewer passes. Monopoint MT may thus be associated with shorter procedural times and less radiation.

Materials/Methods

Anterior circulation large vessel MT cases across four centers were identified, assigning cases to Monopoint, CA, or SA groups based on the first-line technique employed, excluding cases that could not be assigned to one of these three groups. Clinical variables, technical details, times to first and final pass, fluoroscopy time, dose-area product (DAP), and radiation dose were recorded. Univariable and multivariable analyses were performed to compare procedural times and radiation data among treatment groups.

Results

Seventy-seven Monopoint, 32 CA, 42 SA cases were analyzed. Time to first pass was shortest with Monopoint (p < 0.001), as was time to final pass (p < 0.001). There was no significant difference in fluoroscopy time between Monopoint (17.7 min) and CA (17.6, p = 0.835); both were lower than SA (26.4, p < 0.001). DAP was lowest for Monopoint (18,854 µGy*m²) compared to CA (31,325) and SA (29,483, p < 0.001). Radiation dose was lowest with Monopoint (884 mGy) compared to CA (1095) and SA (1994, p < 0.001).

Conclusion

MT for anterior circulation large vessel occlusions had shorter procedural times and involved less radiation with Monopoint compared to CA and SA. Further investigation is warranted to assess other clinical and technical factors that affect procedure duration, DAP, and radiation dose.