Introduction
Aspiration thrombectomy is a procedure widely used for treating acute ischemic stroke, and catheter size selection is an essential aspect of this procedure. The aspiration catheter's size affects the efficacy of the thrombectomy and the safety of the procedure. A large catheter size can increase the chance of clot removal but may also increase the risk of vessel injury and distal embolization. In contrast, a small catheter size may be safer but less effective in removing the clot. In this article, we review the impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy.
Catheter size - what is the optimal size?
The optimal catheter size for aspiration thrombectomy is a subject of debate, with various manufacturers providing different catheter sizes. Current studies suggest that the catheter's size should be determined based on the intracranial vessel size, the clot burden, and the collateral status. In general, a larger catheter size is preferred for larger vessels and higher clot burden, while a smaller catheter is used for smaller vessels and lower clot burden.
Impact of catheter size on revascularization rates
The revascularization rates are crucial in aspiration thrombectomy, and catheter size is a significant factor affecting this outcome. Studies have shown that a larger catheter size is associated with higher revascularization rates. For example, a study by Turk et al. found that the revascularization rate was 57.1% for a 5F catheter and 75% for a 6F catheter. Similarly, a study by Nambiar et al. found that a larger catheter size (>5.5F) was associated with a higher first-pass reperfusion rate.
Impact of catheter size on time to reperfusion
Time to reperfusion is another crucial outcome in aspiration thrombectomy. Studies have shown that a larger catheter size is associated with shorter time to reperfusion. For example, a study by Turk et al. found that the time from groin puncture to reperfusion was shorter with a 7F catheter than with a 5F catheter (37.4 min vs. 50.5 min). Similarly, a study by Turk et al. found that the time to reperfusion was shorter with a larger catheter size (>5.5F). This outcome is essential in acute ischemic stroke, where time is of the essence.
Impact of catheter size on safety
Safety is another critical aspect of aspiration thrombectomy, and larger catheter sizes may increase the risk of complications. Studies have shown that a larger catheter size is associated with more vessel injury, distal embolization, and hemorrhagic transformation. For example, a study by Ciccio et al. found that a 6F catheter was associated with a higher incidence of dissection (16.7%) than a 5F catheter (3.6%). Similarly, a study by Nambiar et al. found that a larger catheter size (>5.5F) was associated with a higher incidence of distal embolization.
Conclusion
All in all, aspiration catheter size is an essential factor in aspiration thrombectomy, affecting both efficacy and safety outcomes. An optimal catheter size should be selected based on the intracranial vessel size, clot burden, and collateral status. Studies have shown that a larger catheter size is associated with higher revascularization rates and shorter time to reperfusion. However, larger catheter sizes may also increase the risk of complications, such as vessel injury, distal embolization, and hemorrhagic transformation. Therefore, the selection of the catheter size should be carefully considered, taking into account the patient and the procedural factors.