P-010 First Line Direct Contact Aspiration Versus Stent-Retriever Based Techniques: Real-World Comparative Thrombectomy Outcomes from the NVQI-QOD Acute Ischemic Stroke Registry

Introduction Mechanical thrombectomy is the standard of care treatment for large-vessel acute ischemic stroke and associated with significant improvement in long-term functional outcomes. Early and complete recanalization are paramount in achieving optimal patient outcomes. Though several revascularization techniques have been described, direct contact aspiration and clot removal via stent-retriever remain the foundation of endovascular stroke thrombectomy. Utilizing the NeuroVascular Quality Initiative - Quality Outcomes Database (NVQI-QOD) Acute Ischemic Stroke Registry, we present real-world data on first-line practice for treatment of emergent large vessel occlusions (ELVOs), comparing angiographic and clinical outcomes between direct contact aspiration and stent-retriever mechanical thrombectomy techniques. Methods Retrospective analysis of the NVQI-QOD registry data was performed. We included patients with ELVOs that underwent mechanical thrombectomy with age > 18 years and presenting NIHSS ≥ 6. We compared procedural times, recanalization efficacy, and clinical outcomes, including in-hospital mortality and discharge NIHSS. Results We identified a total of 2381 patients that met inclusion criteria. 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 baseline median NIHSS scores (16 vs. 17, p = 0.25) or median ASPECTS scores (9 vs. 9, p = 0.7). No significant differences were seen in time last known well to puncture times (282 min vs. 280 min, p = 0.22) or recanalization time (323 min vs. 322 min, p= 0.39), ED to puncture time (75 min vs. 71 min, p = 0.25) or recanalization time (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). Although there was no difference in successful recanalization (TICI 2b-3) between the 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 adjunctive 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 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 registry, stent-retriever techniques were associated with higher rates of complete recanalization when compared to direct contact aspiration alone, but successful (TICI 2b-3) recanalization rates were similar. There were no statistically significant differences in procedure times, clinical outcomes at discharge, or in-hospital mortality. Disclosures A. Mahapatra: None. Y. Moazeni: None. T. Patterson: None. R. Abdalla: None. J. Tsai: None. N. Moore: None. M. Bain: None. G. Toth: None. S. Ansari: None. M. Hussain: None.