Bigger is Still Better: A Step Forward in Reperfusion With React 71

BACKGROUND: While multiple new larger-bore aspiration catheters have been introduced for stroke thrombectomy, sizeable cohort outcome studies are lacking along with meaningful comparative studies to evaluate whether they represent a clinically relevant improvement compared to predecessors. OBJECTIVE: To evaluate comparative angiographic and clinical outcomes between an 071 and 068 aspiration catheter. METHODS: The authors reviewed an institutional thrombectomy database extracting the first 150 consecutive cases utilizing React 71 (Medtronic, Dublin, Ireland) with a comparison of background/demographic, procedural, angiographic, and clinical outcome variables to a cohort of patients treated with our previously most frequently utilized 0.068-inch aspiration catheter. RESULTS: In our React 71 cohort, successful reperfusion (thrombolysis in cerebral infarction [TICI] 2b-3) was achieved in 95% of cases. In comparison to a prior cohort of 96 patients treated with a 0.068-inch catheter, there was no statistically significant difference in rates of successful reperfusion (TICI 2b-3), initial disposition, and 90-d outcome. However, the frequency of single pass cases was significantly higher in the React 71 cohort (47% vs 35%, P =.019 on multivariate analysis) along with the rate of TICI 2c-3 reperfusion after the first pass (26% vs 14%, P =.019 on multivariate analysis), and final TICI 2c-3 reperfusion (39% vs 28%, P =.04 on multivariate analysis). CONCLUSION: While rates of TICI 2b-3 reperfusion and clinical outcome results were similar, our study suggests that a newer, larger bore aspiration catheter may be associated with a greater frequency of single pass cases and higher quality reperfusion, judged as TICI 2c-3 frequency after the first and final pass.

Automated summary

The new larger-bore aspiration catheter React 71 achieved higher rates of successful reperfusion, with significantly more single pass cases and higher quality reperfusion compared to the previous 0.068-inch catheter.