Thrombectomy-Related Emboli: Direct Aspiration versus Stent Retriever Thrombectomy for Acute Ischemic Stroke: Our Experience and Literature Review

Abstract

Objective: Thrombectomy-related emboli (TRE) represent a potentially dangerous complication of thrombectomy procedures for acute ischemic stroke. The aim of this study was to compare the rate of TRE in aspiration thrombectomy (ASP) and stent retriever thrombectomy techniques.

Methods: We retrospectively compared clinical and radiologic outcomes of 2 groups of consecutive patients with stroke, ASP group and SRT group, with TRE rates as the primary study endpoint. Emboli were classified as either affected territory emboli or unaffected territory emboli (uTRE). Relevant literature was also reviewed.

Results: The ASP group had better rates of successful recanalization (97.1% vs. 77.1%, P = 0.02), mean number of passes per case (2.0 vs. 3.3, P = 0.04), and mean operative time (34.1 minutes vs. 84.8 minutes, P < 0.0001). Thrombectomy technique (ASP vs. SRT) did not appear to predict rates of either affected territory emboli (odds ratio [OR] = 1.24, 95% confidence interval [CI] 0.33-4.63, P = 0.74) or uTRE (OR = 5.67, 95% CI 0.60-53.42, P = 0.13). Longer operative time was linked to higher uTRE rates (OR = 1.03, 95% CI 1.01-1.05, P = 0.02). ASP technique (OR 0.1, 95% CI 0.01-0.88; P = 0.04) and shorter operative time (OR = 0.98, 95% CI 0.97-0.99, P = 0.03) were linked to better rates of successful recanalization.

Conclusions: The applied thrombectomy technique (ASP vs. SRT) is not an independent predictor of TRE rates. Operative time tends to affect the rates of uTRE and successful recanalization. The ASP technique offers higher rates of successful recanalization in less operative time.

Keywords: Acute stroke; Aspiration; Emboli; Stent retrieval; Thrombectomy.