PT  - JOURNAL ARTICLE
AU  - Schartz, Derrek
AU  - Ellens, Nathaniel
AU  - Kohli, Gurkirat Singh
AU  - Rahmani, Redi
AU  - Akkipeddi, Sajal Medha K
AU  - Colby, Geoffrey P
AU  - Hui, Ferdinand
AU  - Bhalla, Tarun
AU  - Mattingly, Thomas
AU  - Bender, Matthew T
TI  - Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy
AID  - 10.1136/jnis-2022-019246
DP  - 2023 Sep 01
TA  - Journal of NeuroInterventional Surgery
PG  - e111--e116
VI  - 15
IP  - e1
4099  - http://jnis.bmj.com/content/15/e1/e111.short
4100  - http://jnis.bmj.com/content/15/e1/e111.full
SO  - J NeuroIntervent Surg2023 Sep 01; 15
AB  - Background Direct aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood.Methods A systematic literature review and meta-regression analysis was completed to evaluate the impact of primary aspiration thrombectomy outcomes based on the ID of the aspiration catheter. Primary outcome measures were: final recanalization of modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3 with aspiration only and with rescue modalities, first pass effect (FPE), need for rescue modalities, intracranial hemorrhagic complication rates, and functional outcomes of 90-day modified Rankin Scale (mRS) of 0–2.Results 30 studies were identified with 3228 patients. Meta-regression analysis revealed a significant association between increasing aspiration catheter ID and FPE (p=0.032), between ID and final recanalization with aspiration only (p=0.05), and between ID size and recanalization including cases with rescue modalities (p=0.002). Further, subgroup analysis indicated that catheters with an ID ≥0.064 inch had a lower rate of need for rescue than smaller catheters (p=0.013). Additionally, catheters with an ID ≥0.068 inch had a higher rate of intracranial bleeding complications (p=0.025). Lastly, no significant association was found in functional outcomes overall.Conclusions Larger aspiration catheters are associated with a higher rate of FPE, final recanalization with only an aspiration catheter, and in cases with rescue modalities, though with a higher rate of hemorrhagic complications. These findings confirm that aspiration catheter size functions as a variable in aspiration thrombectomy, which should be considered in future study and trial design.Data are available upon reasonable request.