Clinical Effects of Using the Combined Technique in the First Attempt for Acute Large-vessel Occlusion, with Specific Reference to Age Differences

The combined technique (simultaneous use of a stent retriever and contact aspiration) is widely used for mechanical thrombectomy to treat acute large-vessel occlusions, but its clinical benefits remain unclear. We compared the efficacy and safety of different vessel-recanalization strategies on clinical outcomes across age groups. We analyzed 301 consecutive patients with internal carotid or middle cerebral artery occlusions. Between January 2017 and March 2021, 145 patients underwent single-device mechanical thrombectomy (stent retriever or contact aspiration) as the first-line strategy. Between April 2021 and December 2023, the combined technique was used as the first-line strategy in 96 patients. The modified first-pass effect (Thrombolysis in Cerebral Infarction grade ≥2b), final reperfusion outcomes, and functional outcomes were compared between strategy groups in patients <75 years and ≥75 years. In patients aged <75 years, the modified first-pass effect rate was significantly higher in the first-line combined-technique group than in the first-line single-device group (68.1% vs. 38.1%, p = 0.033), but favorable functional outcomes were similar. In patients ≥75 years, the first-line combined-technique group showed higher modified first-pass effect rates (61.3% vs. 42.7%, p = 0.03) and more frequent favorable functional outcomes than the first-line single-device group (31.3% vs. 13.4%, p = 0.0079). Thus, when performing mechanical thrombectomy for acute large-vessel occlusions, the combined technique should be used as a first-line strategy in older patients, as it is associated with more favorable functional outcomes than a first-line single-device strategy. In contrast, the favorable outcome rate in younger patients does not appear to differ by strategy.