Abstract 045: First‐Line Mechanical Thrombectomy Device in Intracranial Atherosclerotic Large Vessel Occlusion

Introduction First‐line mechanical thrombectomy devices are associated with heterogeneous functional and safety outcomes in large vessel ischemic stroke. Successful recanalization rates are influenced by associated technical difficulties of navigating torturous vessels and interactions with recalcitrant thrombi of atherosclerotic lesions. As such, studies are required to evaluate these devices to determine the optimal initial thrombectomy approach in patients with these lesions. Method This is an analysis of the RESCUE‐ICAS international prospective observational registry which included patients with residual stenosis (50‐99% reperfusion) following successful mechanical thrombectomy. Patients were dichotomized into those receiving first‐line aspiration catheter or stentriever devices. Primary and secondary efficacy outcomes were defined as excellent functional outcomes (modified Rankin Scale 0‐2) and procedure times, respectively. Primary safety outcomes were defined symptomatic intracranial hemorrhage (sICH) rates. Multivariate analysis was performed on the primary outcome. Results There were four‐hundred‐twenty‐six patients included in this analysis with 218 and 208 patients receiving first‐line aspiration catheter and stentriever devices, respectively. Patients were generally older (median 68 years old) Caucasian (59%) males (61%). Patients in the aspiration catheter cohort were more likely to have dyslipidemia (55% vs 45% p = 0.04) and prior stroke (28% vs 19% p = 0.03) compared to the stentriever cohort; no other significant differences were noted. At 90‐days, there were equivalent rates of excellent functional outcomes in the aspiration and stentriever cohorts (35.4% vs 31.4% p = 0.48) and redemonstrated following multivariate analysis (OR 0.90 95% CI 0.59 ‐ 1.37; p = 0.62). Yet, aspiration catheters were noted to have shorter procedure times (45 mins vs 62 mins p < 0.001). Additionally, there was a trend towards lower sICH rates in the aspiration cohort (5% vs 9.6% p =0.07) compared to the stentriever cohort. Conclusion There were equivalent primary functional outcomes in patients with atherosclerotic large vessel occlusions treated with either aspiration catheter or stentriever devices yet, procedure times favored aspiration catheters. There was a trend towards lower symptomatic ICH rates with first‐line aspiration catheters. Further randomized studies are required to further evaluate procedural benefits and risks.