1371 Safety and Efficacy of Direct Aspiration Thrombectomy Over Microwire Technique

INTRODUCTION: Several techniques of mechanical thrombectomy (MT) for acute ischemic stroke are performed. With the advent of newer technology, techniques to perform MT without the traditional triaxial system have been developed. METHODS: A prospectively collected database of consecutive patients who underwent MT was analyzed. Multiple patient, stroke, technique, and followup-related variables were analyzed. All included patients had ICA terminus, M1, proximal M2 occlusions or combinations. All procedures were performed with a single large microwire (Aristotle 0.024in). Aspiration catheters used were variable and selected by the surgeon. RESULTS: Among 245 patients who underwent MT, aspiration catheter over microwire was successfully utilized in 109 patients (44%) (Group 1), aspiration catheter over microwire-microcatheter assembly was required in 36 patients (15%) either as first-line technique or after failed attempt without microcatheter (Group 2), “SNAKE” technique was used in 18 patients (7%) (Group 3), and stent retriever after failed aspiration thrombectomy in 82 patients (33%) (Group 4). Mean number of passes was significantly higher in Group 4 compared to Group 1 and Group 2, and lesser in Group 3 versus Group 2. Reperfusion outcomes were also similar between the various groups- Group 1 (TICI 2C/3 = 88%, 2B=11%), Group 2 (TICI 2C/3 = 75%, 2B = 14%), Group 3 (TICI 2C/3 = 89%, 2B = 11%), Group 4 (TICI 2C/3 = 54%, 2B = 33%); p>0.05 between groups. There was no difference in mean number of passes between Group 1 vs. Group 2. There was no difference in procedure-related complications between groups. Postoperative hemorrhagic conversion was similar between groups. CONCLUSIONS: Direct aspiration pass technique thrombectomy over large microwires designed for intracranial access is safe and effective with outcomes comparable to traditional techniques in a real-world experience. This could provide potential cost savings and procedural efficiency during MT.