Impact of aspiration catheter inner diameter on first-pass effect: A systematic review and meta-analysis.
Seyed Behnam Jazayeri, Abdullah Reda, Jonathan Cortese et al.
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In 30 seconds
This systematic review and meta-analysis examined whether distal inner diameter of contact aspiration catheters was associated with first-pass revascularization during mechanical thrombectomy. Across 34 articles involving 4,831 patients, pooled first-pass effect (TICI 2c–3) rates were 27.7% for medium-bore, 46.6% for large-bore, and 58.3% for super-large-bore catheters. The rate was significantly higher with super-large-bore catheters than with the other groups (χ² = 7.26, p = 0.03). Modified first-pass effect rates showed a similar pattern, but the findings indicate association rather than causation.
Key findings
- First-pass effect rates were 27.7% (95% CI, 15.1-45.3) for medium-bore, 46.6% (95% CI, 33.7-59.9) for large-bore, and 58.3% (95% CI, 44.8-70.7) for super-large-bore catheters.
- Super-large-bore catheters had significantly higher first-pass effect rates than the other groups (χ² = 7.26, p = 0.03).
- Modified first-pass effect rates were 51.1% for medium-bore, 60.0% for large-bore, and 80% for super-large-bore catheters (χ² = 8.14, p = 0.03).
Why it matters
Achieving substantial revascularization in one thrombectomy pass is a clinically relevant procedural outcome. The pooled results suggest catheter inner diameter may be associated with the likelihood of first-pass success, providing comparative evidence that can inform evaluation of aspiration-device strategies. Because the analysis synthesizes reported studies rather than testing catheter sizes in a randomized comparison, the observed differences should not be interpreted as proof that larger catheters cause better outcomes.
What to keep in mind
The analysis pooled results from 34 articles; the abstract does not report a randomized comparison of catheter sizes, so differences may reflect factors beyond catheter diameter.