Operator device-selection preference did not correlate with superior first-pass effect rates in stroke thrombectomyMore experience improves stroke treatment success but not doctor preference

medRxiv Published July 9, 2026 Study authors: Yelam, T.; Martins, P. N.; Dolia, J.; Batista dos Reis, S.; Grossberg, J. A.; Pabaney, A. H.; G Nogu… DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Note that operator preference for a specific thrombectomy technique did not correlate with superior first-pass effect rates.

This retrospective analysis of prospective data evaluated 1405 patients undergoing thrombectomy at a comprehensive stroke center to examine the relationship between operator device-selection preference and clinical outcomes.

The study analyzed first-pass effect (FPE) rates, parenchymal hemorrhage rates, and learning curves for contact aspiration. The results indicated that the technique with the highest FPE rate was never the most frequently used technique by operators. Furthermore, the probability of achieving FPE was independent of an operator's previous cumulative success with a specific technique.

While increasing case volume was associated with higher FPE on average, parenchymal hemorrhage rates were comparable for individual operators regardless of the technique used. Notably, only contact aspiration demonstrated a significant learning curve.

A primary limitation is that this study is a retrospective analysis of prospective data. Clinical implications suggest that while experience (case volume) correlates with better outcomes, specific operator preferences do not necessarily translate to superior reperfusion results. The finding regarding the learning curve for contact aspiration may inform training protocols for neurointerventionists.

How this fits prior evidence

How this fits prior evidence: This study addresses a gap in understanding how individual operator behavior impacts outcomes. While previous coverage noted that the Route 92 Reperfusion System increases first-pass effect and near-complete reperfusion in AIS-LVO, this study clarifies that personal preference for any specific technique does not correlate with higher FPE rates. Additionally, it confirms that parenchymal hemorrhage rates remain comparable across different techniques regardless of operator choice.

When doctors treat patients who have suffered a stroke, they must make quick decisions about which tools and techniques to use. This study looked at over 1,400 patients treated at a large stroke center to see if the doctor's personal preference for a specific method actually led to better results for the patient.

The data showed that a doctor's favorite technique did not lead to better outcomes. Instead, the most successful methods were not necessarily the ones used most often by the doctors. However, there was a clear link between experience and success: as the total number of cases a doctor performed increased, their success rate in achieving a first-pass effect (getting blood flowing again quickly) also went up.

One specific method, called contact aspiration, showed a learning curve, meaning it took more practice to master. Despite these differences in skill levels and techniques, the risk of bleeding in the brain remained similar for all doctors regardless of which method they chose. Because this was a retrospective look at past data, we cannot say for certain that one specific technique is better than another.

What this means for you:

More experience improves stroke treatment success, but a doctor's personal preference for a technique does not.

Common questions

Does a doctor's preference for a specific technique affect my treatment?

The study found that a doctor's personal preference for a specific technique did not correlate with better outcomes. While some techniques may have learning curves, the risk of bleeding in the brain was similar across all methods used by individual doctors.

Does experience help improve stroke treatment results?

Yes, the study found that as the total number of cases a doctor performed increased, their success rate in achieving a first-pass effect—which means getting blood flowing again quickly—also went up on average.

Are there different risks depending on the technique used?

The study found that parenchymal hemorrhage rates (bleeding in the brain) were comparable for individual doctors regardless of which specific technique they chose to treat the stroke.

Study Details

Study typeRct

Sample sizen = 839

EvidenceLevel 2

PublishedJul 2026

View Original Abstract ↓

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.

Operator device-selection preference did not correlate with superior first-pass effect rates in stroke thrombectomyMore experience improves stroke treatment success but not doctor preference

How this fits prior evidence

Common questions

Study Details

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Operator device-selection preference did not correlate with superior first-pass effect rates in stroke thrombectomyMore experience improves stroke treatment success but not doctor preference

How this fits prior evidence

Common questions

More on Stroke

Study Details

Intravenous tenecteplase improves functional outcomes but increases hemorrhage risk in non-large vessel occlusion acute ischemic stroke

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Clinical research that matters. Delivered to your inbox.

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