Abstract 1122‐000196: First‐Line Direct Contact Aspiration Versus Stent‐Retriever Technique: Real‐World Comparative Outcomes for Successful Mechanical Thrombectomy

Introduction : Mechanical thrombectomy for large‐vessel acute ischemic stroke has been adopted as the standard of care treatment across the world, with dramatic improvements in long‐term functional outcomes for an otherwise debilitating disease process. Timely and complete recanalization are paramount in achieving good outcomes. Though several revascularization techniques have been described, direct contact aspiration and clot removal via stent‐retriever remain the foundation of endovascular stroke therapy. Utilizing the NeuroVascular Quality Initiative – Quality Outcomes Database (NVQI‐QOD), we present our data on real‐world, first‐line practice for treatment of large vessel occlusions (LVOs), and compare angiographic and clinical outcomes between direct contact aspiration and stent‐retriever mechanical thrombectomy techniques. Methods : Retrospective analysis of the NVQI‐QOD was performed. We included patients with LVOs that underwent mechanical thrombectomy who were older than 18 and whose baseline NIHSS ≥ 6. We compared procedural times, rate of revascularization, and outcomes, including in‐hospital mortality and discharge NIHSS. Results : We identified a total of 2381 patients who met the inclusion criteria, of which 998 (41.9%) underwent treatment with direct contact aspiration alone and 1383 (58.1%) underwent treatment utilizing a stent‐retriever (with or without local aspiration). There were no significant differences in the baseline median NIHSS scores (16 vs 17, p = 0.25) or baseline median ASPECTS scores (9 vs 9, p = 0.7). No significant difference was seen in time metrics, including last known well to puncture (282 min vs. 280 min, p = 0.22) or recanalization (323 min vs. 322 min, p = 0.39), ED to puncture (75 min vs. 71 min, p = 0.25) or recanalization (158 min vs. 160 min, p = 0.55), or median procedure times between the two groups (23 vs 23 min, p = 0.64). The median number of passes required for recanalization was lower in the direct aspiration group (1 vs 2, p = 0.01). Though there was no difference in successful recanalization (TICI 2B‐3) between the two groups (86.1% vs 88%, p = 0.71), there was a lower rate of complete recanalization (TICI 2C‐3) in the direct aspiration group (46% vs 51.7%, p = 0.007). There was also a lower rate of adjunct treatments (defined as the use of GP IIb/IIIa inhibitors, P2Y12 inhibitors, and/or salvage angioplasty and/or stenting) required in the direct contact aspiration group (36.1% vs 44.4%, p < 0.001). There were no differences noted in discharge NIHSS scores (5 vs 4, p = 0.21) or in‐hospital mortality (22.2% vs 22.5%, p = 0.92). Conclusions : In the NVQI‐QOD, stent‐retriever techniques were associated with higher rates of complete recanalization when compared to direct contact aspiration alone, although acceptable (TICI 2B‐3) recanalization rates were similar. There were no statistically significant differences in procedure times or clinical outcomes at discharge.