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, real-world 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. 18317; difference, 3370; 95% CI, 2976-3764). 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.