Background and purpose The first-pass effect (FPE), defined as a first-pass Expanded Treatment in Cerebral Ischaemia (eTICI) 2c/3 reperfusion, has emerged as a key metric of efficacy in mechanical thrombectomy (MT) for acute ischaemic stroke. The proximal balloon occlusion together with direct thrombus aspiration during stent retriever thrombectomy (PROTECT)-PLUS technique consists in the use of a balloon guide catheter and a combined MT approach involving contact aspiration and a stent retriever. The aim of this study is to assess the effectiveness and safety of the PROTECT-PLUS technique using distal aspiration catheters (DACs) with different inner diameters by comparing the large-bore DAC Catalyst 7 versus the use of medium-bore DACs. Methods Retrospective analysis of a prospectively maintained database of patients treated with PROTECT-PLUS using Catalyst 7, Catalyst 6 or Catalyst 5 with an occlusion of either the terminal carotid artery or the M1 or M2 segments of the middle cerebral artery from 2018 to 2020 in two comprehensive stroke centres. Baseline characteristics and procedural, safety and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed in order to find independent predictors of FPE. Results We identified 238 consecutive patients treated with PROTECT-PLUS as front-line approach using Catalyst 7 (n=86), Catalyst 6 (n=78) and Catalyst 5 (n=76). The rate of FPE was higher with Catalyst 7 (54%) than Catalyst 6 (33%, p=0.009) and Catalyst 5 (32%, p=0.005), in addition to higher final eTICI 2c/3 reperfusion rates, shorter procedural times, lower need of rescue therapy and fewer procedure-related complications. After multivariable analysis the sole independent factor associated to FPE was the use of Catalyst 7 (OR 2.34; 95% CI 1.19 to 4.58; p=0.014). Conclusion Further development of combined MT by incorporating larger-bore aspiration catheters is associated with higher reperfusion rates, shorter procedure times, and lower need of rescue therapy while reducing the complication rates. Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

中文翻译：

---

抽吸导管尺寸对联合使用接触抽吸和支架取栓技术的首过效应的影响

背景和目的 首过效应 (FPE) 定义为脑缺血 (eTICI) 2c/3 再灌注中的首过扩大治疗，已成为急性缺血性卒中机械取栓 (MT) 疗效的关键指标。在支架取栓器血栓切除术 (PROTECT)-PLUS 技术中，近端球囊闭塞和直接血栓抽吸包括使用球囊引导导管和涉及接触抽吸和支架取栓器的组合 MT 方法。本研究的目的是通过比较大口径 DAC Catalyst 7 与使用中口径 DAC 来评估使用具有不同内径的远端抽吸导管 (DAC) 的 PROTECT-PLUS 技术的有效性和安全性。方法 回顾性分析 2018 年至 2020 年两个使用催化剂 7、催化剂 6 或催化剂 5 治疗颈动脉末端或大脑中动脉 M1 或 M2 段的患者的前瞻性维护数据库综合卒中中心。比较各组的基线特征和程序、安全性和临床结果。进行多变量逻辑回归分析以找到FPE的独立预测因子。结果 我们确定了 238 名连续接受 PROTECT-PLUS 治疗的患者，作为使用 Catalyst 7 (n=86)、Catalyst 6 (n=78) 和 Catalyst 5 (n=76) 的一线方法。除了更高的最终 eTICI 2c/3 再灌注率外，催化剂 7 (54%) 的 FPE 率高于催化剂 6 (33%, p=0.009) 和催化剂 5 (32%, p=0.005)，更短的手术时间，更少的抢救治疗需求和更少的手术相关并发症。多变量分析后，与 FPE 相关的唯一独立因素是催化剂 7 的使用（OR 2.34；95% CI 1.19 至 4.58；p=0.014）。结论 通过合并更大口径的抽吸导管进一步发展联合 MT 与更高的再灌注率、更短的手术时间和更低的抢救治疗需求相关，同时降低并发症发生率。可根据合理要求提供数据。支持本研究结果的数据可根据合理要求从相应作者处获得。58; p = 0.014)。结论 通过合并更大口径的抽吸导管进一步发展联合 MT 与更高的再灌注率、更短的手术时间和更低的抢救治疗需求相关，同时降低并发症发生率。可根据合理要求提供数据。支持本研究结果的数据可根据合理要求从相应作者处获得。58; p = 0.014)。结论 通过合并更大口径的抽吸导管进一步发展联合 MT 与更高的再灌注率、更短的手术时间和更低的抢救治疗需求相关，同时降低并发症发生率。可根据合理要求提供数据。支持本研究结果的数据可根据合理要求从相应作者处获得。