Abstract 231: Comparison of Device Costs and Recanalization Results for Mechanical Thrombectomy performed with the Monopoint Aspiration System, Conventional Contact Aspiration, or Combined Stentreiver/Aspiration
Authors: Alexander M. , English J. , Khangura R. , Kim W. , Varjavand B. , Kim J. , Chaudhry T. , Settecase F. 
Published: January 2025

Introduction/Purpose
As endovascular therapy for the treatment of acute ischemic stroke (AIS) has become standard of care, devices and techniques have evolved rapidly. Variability in options is accompanied by variability in device costs. This analysis examines device costs for the Route 92 0.088” Monopoint system compared to contact aspiration (CA) with previously available 0.060‐0.072” devices or combination stentriever/aspiration (SA) MT.

Materials/Methods
According to an IRB‐approved protocol, retrospective analysis was performed of AIS patients treated with MT across four high‐volume stroke centers in a regional health system. Querying prospectively maintained treatment records, patients with large vessel occlusion (LVO) of the ICA terminus or M1 segment of the middle cerebral artery were identified. Patient demographics, clinical presentation, LVO location, and technique and equipment utilized were noted. Patients treated with first‐line technique using the 0.088” Monopoint system for off‐label performance of mechanical thrombectomy were identified. For comparator groups, patients treated before the availability of the Monopoint system were identified and categorized as CA or SA based on the first‐line technique performed for MT. Patients with tandem occlusions, patients requiring rescue/bailout stenting for atherosclerosis, and patients treated with a first‐line technique not clearly within one of the three above‐described cohorts were excluded to limit confounding. All devices used in the procedure were then noted, and total costs were tabulated using uniform system‐wide prices in August 2024 regardless of procedure date to ensure effective cost comparisons. To compare device costs and MT passes among treatment groups, paired t‐tests were performed. Fisher's exact test was performed to assess crossover to a different technique, first pass effect (FPE) rates, and rates of final mTICI 2c/3 among the three groups.

Results
58 patients met inclusion criteria with sufficient data for analysis. 20 were identified in the Monopoint group, 20 in CA, and 18 in SA. Monopoint and CA groups had identical FPE rates (60%), while Monopoint had a higher rate of final mTICI 2c/3 (95.0%) compared to CA (80.0%). For SA, FPE was 38.9% and mTICI 2c/3 83.3%. These differences were not significant for FPE (0.367) or final mTICI (p=0.374). Mean number of passes was 1.80 for Monopoint, 1.85 for CA, and 2.50 for SA (p=0.765). No crossover occurred in the Monopoint group (p<0.001). Crossover rates were 30.0% in the CA group and 16.7% for SA. Smaller devices for distal occlusions were required in 30.0% of cases in the Monopoint group; such devices were needed in 30.0% of CA cases and 22.2% of SA cases. Total device costs were lowest in the Monopoint group ($7632, p<0.001), compared to the CA group ($10,013) and SA group ($22,103).

Conclusion
Mechanical thrombectomy for occlusions of the ICA terminus or M1 had lower total costs of devices used when performed with the Monopoint system compared to contact aspiration performed with other devices or combination of stentriever and aspiration. The Monopoint group required no crossover to other techniques and resulted in FPE mTICI 2c/3 rates comparable to CA and superior to SA.