Contact Aspiration Combined with a Stent Retriever versus Contact Aspiration Alone in Mechanical Throm bectomy for Acute Ischemic Strokes: A Nationwide Analysis Using the Diagnosis Procedure Combination Database

Saki Nakashima; Shuhei Egashira; Shotaro Aso; Hideo Yasunaga; Kenichiro Sato; Yoshiki Niimi; Toshiaki Isogai; Hiroki Matsui; Yuichiro Shirota; Masashi Hamada; Kiyohide Fushimi; Tatsushi Toda; Satoshi Kodama

doi:10.5797/jnet.oa.2025-0105

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Contact Aspiration Combined with a Stent Retriever versus Contact Aspiration Alone in Mechanical Throm bectomy for Acute Ischemic Strokes: A Nationwide Analysis Using the Diagnosis Procedure Combination Database

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Contact Aspiration Combined with a Stent Retriever versus Contact Aspiration Alone in Mechanical Throm bectomy for Acute Ischemic Strokes: A Nationwide Analysis Using the Diagnosis Procedure Combination Database

Saki Nakashima, Shuhei Egashira, Shotaro Aso, Hideo Yasunaga, Kenichiro Sato, Yoshiki Niimi, Toshiaki Isogai, Hiroki Matsui, Yuichiro Shirota, Masashi Hamada, …

Journal of neuroendovascular therapy, Vol.19(1), 20250105

01/01/2025

DOI: 10.5797/jnet.oa.2025-0105

PMID: 41112963

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Abstract

Objective: The technique combining a stent retriever (SR) and contact aspiration (CA) has been widely used in mechanical thrombectomy for acute ischemic stroke. However, advancements in large-bore aspiration catheters suggest that CA alone may achieve comparable therapeutic outcomes, while streamlining the procedure. Nevertheless, realworld evidence directly comparing these approaches is limited. Methods: We identified patients hospitalized for ischemic stroke who underwent mechanical thrombectomy between April 2020 and March 2023 from the Japanese national inpatient Diagnosis Procedure Combination database. Patients treated with CA or CA combined with SR (CA + SR) were enrolled. Propensity score overlap weighting was performed to adjust for confounders. The outcomes were intracranial hemorrhage (ICH), functional independence at discharge, in-hospital mortality, and total hospitalization cost. Results: Among 17589 eligible patients, 14892 underwent CA + SR and 2697 received CA. The adjusted proportions of ICH were comparable between the groups (1.4% vs. 1.3%; adjusted risk difference [aRD], 0.1%; 95% confidence interval [CI], -0.5% to 0.5%). The CA + SR group had a lower proportion of functional independence at discharge (28.7% vs. 36.2%; aRD, -7.5%; 95% CI, -9.5% to -5.4%) and higher in-hospital mortality (11.4% vs. 9.2%; aRD, 2.2%; 95% CI, 1.0%-3.5%). The total hospitalization costs (USD) were higher in the CA + SR group than in the CA group (21687 vs. Conclusions: The proportion of patients with ICH did not differ significantly between the CA + SR group and CA groups. CA + SR was associated with worse functional outcomes, higher in-hospital mortality, and higher costs.

Surgery

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

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Title: Subtitle: Contact Aspiration Combined with a Stent Retriever versus Contact Aspiration Alone in Mechanical Throm bectomy for Acute Ischemic Strokes: A Nationwide Analysis Using the Diagnosis Procedure Combination Database
Creators: Saki Nakashima - The University of Tokyo
Shuhei Egashira - Toranomon Hospital
Shotaro Aso - The University of Tokyo
Hideo Yasunaga - University of Tokyo Health Sciences
Kenichiro Sato - University of Tokyo Hospital
Yoshiki Niimi - University of Tokyo Hospital
Toshiaki Isogai - Tokyo Metropolitan Tama Medical Center
Hiroki Matsui - University of Tokyo Health Sciences
Yuichiro Shirota - The University of Tokyo
Masashi Hamada - The University of Tokyo
Kiyohide Fushimi - Inst Sci Tokyo, Grad Sch, Dept Hlth Policy & Informat, Tokyo, Japan
Tatsushi Toda - The University of Tokyo
Satoshi Kodama - University of Iowa Hospitals and Clinics
Resource Type: Journal article
Publication Details: Journal of neuroendovascular therapy, Vol.19(1), 20250105
DOI: 10.5797/jnet.oa.2025-0105
PMID: 41112963
ISSN: 1882-4072
eISSN: 2186-2494
Publisher: JAPANESE SOC NEUROENDOVASCULAR THERAPY
Number of pages: 8
Grant note: 23AA2003; 24AA2006 / Ministry of Health, Labour and Welfare, Japan
Language: English
Date published: 01/01/2025
Academic Unit: Neurology
Record Identifier: 9985178659502771

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