Impact of Operator Technique Preference on Thrombectomy Reperfusion Outcomes

ABSTRACT Background: Randomized trials have shown comparable reperfusion rates among stent-retriever, contact-aspiration, and combined thrombectomy techniques. We aim to evaluate the association between operator device-selection preference and procedural performance metrics. Methods: Retrospective analysis of prospective data from a comprehensive stroke center. Preferred technique was defined as a technique used in >50% of an operator's thrombectomies. Main exposure: proportion of usage of a given technique by operators in a certain period; primary endpoint: rate of first-pass effect(FPE). Results: 1405 patients fit inclusion criteria. The first time period(2019- mid 2022/n=839) included 4 operators(3 experienced/1 starting practice), with CoT being overall used in 58.9%, SR in 24.4%, and CA in 16.7%. The second( mid 2022-2024/n=566) included 4 total operators(2 experienced/2 starting), with CA reaching 48.2%, CoT 39.8% and SR 12.0%. The distribution of techniques varied between intra-/inter-operators and most(75.0%) had a preferred technique. The technique with the highest FPE rate was never the most used technique. The chances of operators achieving FPE were not dependent on the previous cumulative success for a given technique. Increasing case volume was associated with higher FPE on average, but the learning rate differed by technique and only contact aspiration had a significant learning curve. The parenchymal hemorrhage rates were comparable for individual operators regardless of technique. Conclusion: Neurointerventionists tended to rely on a preferred technique, which did not necessarily lead to superior reperfusion outcomes. The cumulative success with a given technique did not increase the likelihood of attaining FPE in subsequent cases. Among new operators, a learning curve for contact aspiration was observed.