First Pass Recanalization Rates of Solitaire vs Trevo vs Primary Aspiration: The Kaiser Southern California Experience.

CONTEXT

New stroke thrombectomy devices have significantly improved recanalization rates in patients with large vessel occlusion. The first pass effect, or complete or near complete recanalization after a single pass of a device, is associated with better outcome. However, it remains unclear whether one technique is superior to the others at first pass recanalization.

OBJECTIVE

The successful recanalization rates of three common techniques: 1) Stent-retriever with the Solitaire or 2) Trevo device, or 3) primary aspiration (PA) with a distal aspiration catheter, were compared across three Kaiser Permanente Southern California Medical Centers over a 5-year period.

DESIGN

Retrospective review of cases between October 2013 and May 2018.

MAIN OUTCOME MEASURE

Successful recanalization after a single pass of a device.

RESULTS

Forty-five percent of Solitaire thrombectomies resulted in first pass success, compared with 31% of Trevo and 39% of PA, not statistically significant (p = 0.26). Adjusted for age, gender, and National Institutes of Health Stroke Scale score, the odds of successful recanalization were 1.90 ± 0.72 (CI 0.90-3.99, p = 0.09) for Solitaire compared with Trevo, and 1.41 ± 0.50 (CI 0.70-2.84, p = 0.33) for aspiration compared with Trevo.

CONCLUSION

In this multi-center cohort, there was no statistical difference in successful first pass recanalization between Solitaire, Trevo, and PA. However, there was a trend towards improved efficacy with the Solitaire device compared to Trevo (OR 1.90, p = 0.09). Additional data are needed to determine the conditions under which design differences may favor one technique over another.