Stroke is a leading cause of death and disability worldwide. Large vessel occlusion (LVO) is one of the major subtypes of ischemic stroke. In the past decade, there have been significant advancements in stroke management, including the development of endovascular techniques such as direct aspiration thrombectomy (DAT) with aspiration catheter. This new approach has emerged as a promising treatment option for LVO stroke and has improved clinical outcomes for patients.
Thrombectomy aspiration catheter is a device that is inserted through the femoral artery and navigated to the site of occlusion. The catheter has a distal tip that creates a vacuum to suck out the thrombus. It is a minimally invasive procedure that can be performed by an experienced interventional radiologist or neurologist. The efficacy of DAT with aspiration catheter has been validated by several randomized controlled trials, including the ASTER and COMPASS trials.
The ASTER trial demonstrated that DAT with thrombus aspiration devices was associated with significantly better functional outcomes than intravenous alteplase alone. The study enrolled 381 patients with LVO stroke and found that the proportion of patients achieving functional independence (modified Rankin Scale score of 0-2) at 90 days was higher in the DAT group (43.7%) than in the alteplase group (28.2%). Furthermore, the rate of symptomatic intracranial hemorrhage was lower in the DAT group (1.6%) than in the alteplase group (6.2%). The study concluded that DAT with aspiration catheter was safe and effective in treating LVO stroke.
The COMPASS trial also demonstrated the superiority of DAT with thrombus aspiration device over mechanical thrombectomy with stent retriever in patients with LVO stroke. The study enrolled 270 patients and found that functional independence at 90 days was achieved in 53.6% of the DAT group and 43.7% of the stent retriever group. The rate of symptomatic intracranial hemorrhage was also lower in the DAT group (2.4%) than in the stent retriever group (6.0%). The study concluded that DAT with aspiration catheter was non-inferior and may be superior to mechanical thrombectomy with stent retriever in the treatment of LVO stroke.
DAT with aspiration catheter has several advantages over other endovascular techniques. First, it has a shorter procedural time and requires less fluoroscopy, which reduces radiation exposure to the patient and staff. Second, it is associated with a lower risk of vessel injury and distal embolization compared to stent retriever. Third, it is a cost-effective alternative to stent retriever, as the aspiration catheter is a single-use device and does not require additional equipment.
In conclusion, DAT with aspiration catheter has emerged as a safe and effective treatment option for LVO stroke. Its efficacy has been validated by several randomized controlled trials, and it offers several advantages over other endovascular techniques. With the increasing prevalence of ischemic stroke and the growing demand for minimally invasive therapies, DAT with aspiration catheter is likely to become the standard of care for LVO stroke.