Matched-Pair Analysis of Patients With Large-Vessel Occlusions Undergoing Thrombectomy Using Single-Plane Versus Biplane Angiography

BACKGROUND: The Mechanical Thrombectomy Global Access for Stroke study demonstrated that access to mechanical thrombectomy (MT) is <3% of demand, with severe disparities across urbanization and income levels. Although biplane angiography is the standard, single-plane systems may offer a cost-effective alternative. We conducted a propensity-matched analysis comparing the procedural and clinical outcomes of MT performed in single-plane versus biplane angiography suites. METHODS: All consecutive stroke MT cases performed at 3 centers (2 single plane and 1 biplane) between 2018 and 2024 were included. Outcomes assessed included rates of first-pass effect (modified Thrombolysis in Cerebral Infarction score ≥2b on first pass), successful reperfusion (final modified Thrombolysis in Cerebral Infarction score ≥2b), time to reperfusion, complication rates, postprocedural symptomatic intracranial hemorrhage, and good clinical outcome (modified Rankin Scale score 0–2) at discharge, 30 days, and 90 days. RESULTS: A total of 51 thrombectomies were performed in single-plane suites, and 367 were performed in biplane suites. After propensity matching, 100 patients (50 in each group) were included. In a multivariable analysis, the type of angiography suite was not significantly associated with successful reperfusion (odds ratio, 3.84 [95% CI, 0.22–68.4]; P =0.36) or good clinical outcome at 90 days (odds ratio, 0.94 [95% CI, 0.18–4.88]; P =0.94). There were no significant differences in reperfusion rates and clinical outcomes in the unmatched comparison. In the unmatched cohort, higher numbers of patients with medium- or distal-vessel occlusions and posterior circulation strokes were treated in the biplane suite. CONCLUSIONS: This propensity score–matched analysis comparing MT for large-vessel occlusion in single-plane versus biplane angiography suites demonstrated no statistically significant differences in procedural and clinical outcomes or safety measures. These results indicate that MT using single-plane angiography suites can serve as a viable alternative for treating proximal large-vessel occlusions within the anterior circulation in areas where establishing a full biplane suite is not feasible.