• Tsuyoshi Ohta, Kanta Tanaka, Junpei Koge, Takeshi Yoshimoto, Yuji Kushi, Masayuki Shiozawa, Manabu Inoue, Tetsu Satow, Koji Iihara, Masafumi Ihara, Masatoshi Koga, Kazunori Toyoda, and Hiroharu Kataoka.
• Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
• Neurosurgery. 2023 Jan 1; 92 (1): 159166159-166.

BackgroundThe single-device simplicity for mechanical thrombectomy (MT) is now challenged by the complementary efficacy of dual-device first-line with a stent retriever and an aspiration catheter.ObjectiveTo compare the outcomes after MT initiated with a single device vs dual devices in acute anterior circulation large vessel occlusion.MethodsPatients who underwent MT for acute internal carotid artery (ICA) or M1 occlusion between 2015 and 2020 were retrospectively analyzed. We divided patients into 2 groups: single-device first-line, defined as patients who underwent first-device pass with either a stent retriever or aspiration catheter, and dual-device first-line, defined as first-device pass with both devices.ResultsOne hundred forty-one patients were in the single-device group, and 119 were in the dual-device group. In the dual-device group, coiling or kinking of the extracranial ICA was more frequent ( P = .07) and the guide catheters were less frequently navigated to the ICA ( P < .001). 37% of the single-device group was converted to dual-device use. The proportions of mTICI ≥ 2c after the first pass were similar (33% vs 32%. adjusted odds ratio 0.91, 95% CI 0.51-1.62). An mRS score of 0 to 2 at 3 months was achieved similarly (53% vs 48%, P = .46). The total cost for thrombectomy devices was lower in the single-device group ( P < .001).ConclusionThe proportions of first-pass mTICI ≥ 2c were not different between the 2 groups with similar functional outcomes, although the dual-device group more likely to have unfavorable vascular conditions.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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