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Efficacy of ADAPT with large-bore reperfusion catheter in anterior circulation acute ischemic stroke: a multicentric Italian experience. Radiol Med 2019; 125:57-65. [DOI: 10.1007/s11547-019-01069-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/06/2019] [Indexed: 02/03/2023]
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Ducroux C, Piotin M, Gory B, Labreuche J, Blanc R, Ben Maacha M, Lapergue B, Fahed R. First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial. J Neurointerv Surg 2019; 12:386-391. [PMID: 31471527 PMCID: PMC7146919 DOI: 10.1136/neurintsurg-2019-015215] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The 'first pass effect' (FPE), which was originally described with stent retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality. OBJECTIVE We report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial. MATERIALS AND METHODS ASTER is a randomized trial comparing angiographic revascularization with the stent retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients. RESULTS FPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients. CONCLUSION In the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted. TRIAL REGISTRATION NUMBER Unique identifier: NCT02523261.
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Affiliation(s)
- Célina Ducroux
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Julien Labreuche
- Department of Biostatistics, EA 2694-Santé Publique,Epidémiologie et Qualité des Soins, CHU Lille, Lille, France
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Malek Ben Maacha
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Robert Fahed
- Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
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Jankowitz BT, Gross BA, Mintz E, Jalgaonkar U, Marchesiello D, Girdhar G, Jadhav AP, Jovin TG. Safety and Efficacy Evaluation of Aspiration Thrombectomy With Large Bore Catheters in a Porcine Model. World Neurosurg 2019; 132:e409-e417. [PMID: 31470150 DOI: 10.1016/j.wneu.2019.08.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Thrombectomy with aspiration catheters has shown to be effective for treatment of intracranial large vessel occlusion (LVO). We present preclinical evaluation of the safety and efficacy of React68 and React71 (Medtronic PLC, Irvine, CA) catheters in animal models of LVO. METHODS In vivo evaluation of catheter safety was performed in superficial cervical, internal maxillary, and renal arteries in a porcine model with or without clot (LVO). Animals were survived for 3 days and 30 days. Angiographic outcomes, usability, and histological parameters were compared for treatment with React68, React71, and ACE68 (Penumbra, Alameda, CA) catheters. RESULTS The in vivo angiographic analysis in a porcine thrombectomy LVO model demonstrated that there was no statistically significant difference in the rate of Thrombolysis in Cerebral Infarction scale 2b/3 recanalization between React68, React71, and ACE68 catheters. There were no physical or neurologic deficits in any of the treated animals throughout the survival period. Histologic analysis showed statistically non-inferior safety profile of React68 and React71 catheters relative to ACE68 catheters, with minimal but similar mild internal elastic lamina disruption and smooth muscle loss, but a lack of inflammation, fibrin deposits, and changes in the adventitia at both time points examined. CONCLUSIONS React68 and React71 aspiration catheters have an excellent safety, efficacy, and usability profile in animal models of LVO.
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Affiliation(s)
- Brian T Jankowitz
- Stroke Institute, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Stroke Institute, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | - Ashutosh P Jadhav
- Stroke Institute, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- Department of Neurology, Cooper Neurological Institute, Camden, New Jersey, USA
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54
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Breakage and Retrieval of an Aspiration Catheter Coil with a Stent Retriever During Mechanical Thrombectomy. World Neurosurg 2019; 130:54-58. [PMID: 31265926 DOI: 10.1016/j.wneu.2019.06.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Some mechanical thrombectomy techniques for acute ischemic stroke use a combination of an aspiration catheter and stent retriever. We experienced a rare case of aspiration catheter coil breakage and subsequent retrieval using a stent retriever. CASE DESCRIPTION A 79-year-old man suddenly developed somnolence, global aphasia, and right hemiplegia. Magnetic resonance imaging revealed acute infarction of the left frontal lobe and occlusion of the left common carotid artery. Thus, using an aspiration catheter and a stent retriever, mechanical thrombectomy was performed. The stent retriever was deployed from the middle cerebral artery to the internal carotid artery and retracted into the aspiration catheter placed in the internal carotid artery proximal to the thrombus. The catheter was bent during retraction of the stent retriever. After thrombus aspiration, the internal carotid and anterior and middle cerebral arteries were successfully reperfused; however, the stent retriever captured a broken section of the winding coil of the aspiration catheter. We suspected that an X-ray marker on the stent retriever broke the winding coil at the bent segment of the aspiration catheter and the stent captured the broken coil. CONCLUSIONS The combined use of an aspiration catheter and a stent retriever may cause unexpected device breakage, especially when the catheter is bent.
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Marnat G, Barreau X, Detraz L, Bourcier R, Gory B, Sgreccia A, Gariel F, Berge J, Menegon P, Kyheng M, Labreuche J, Consoli A, Blanc R, Lapergue B. First-Line Sofia Aspiration Thrombectomy Approach within the Endovascular Treatment of Ischemic Stroke Multicentric Registry: Efficacy, Safety, and Predictive Factors of Success. AJNR Am J Neuroradiol 2019; 40:1006-1012. [PMID: 31122921 DOI: 10.3174/ajnr.a6074] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/18/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE After publications on the effectiveness of mechanical thrombectomy by stent retrievers in acute ischemic stroke with large-vessel occlusion, alternative endovascular approaches have been proposed using first-line aspiration catheters. Several devices are currently available to perform A Direct Aspiration First Pass Technique. The Sofia catheter aspiration has been widely used by interventionalists, but data are scarce about its efficacy and safety. Our aim was to report our multicenter thrombectomy experience with first-line Sofia catheter aspiration and to identify independent prognostic factors of clinical and procedural outcomes. MATERIALS AND METHODS We performed a retrospective analysis of the prospectively maintained Endovascular Treatment of Ischemic Stroke multicentric registry. Data from consecutive patients who benefited from thrombectomy with a first-line Sofia approach between January 2013 and April 2018 were studied. We excluded other first-line approaches (stent retriever or combined aspiration and stent retriever) and extracranial occlusions. Baseline characteristics, procedural data, and angiographic and clinical outcomes were analyzed. RESULTS During the study period, 296 patients were treated. Mean age and initial NIHSS score were, respectively, 69.5 years and 16. Successful reperfusion, defined by the modified TICI 2b/3, was obtained in 86.1% (n = 255; 95% CI, 81.7%-89.9%). Complete reperfusion (modified TICI 3) was obtained in 41.2% (n = 122; 95% CI, 35.5%-47.1%). A first-pass effect was achieved in 24.2% (n = 71; 95% CI, 19.4%-29.6%). A rescue stent retriever approach was required in 29.7% (n = 88; 95% CI, 24.6%-35.3%). The complication rate was 9.5% (n = 28; 95% CI, 6.4%-13.5%). Forty-three percent (n = 122; 95% CI, 37.1%-48.9%) of patients presented with a favorable 3-month outcome (mRS ≤ 2). Older age, M1-occlusion topography, and intravenous thrombolysis use prior to thrombectomy were independent predictors of the first-pass effect. CONCLUSIONS The first-line contact aspiration approach appeared safe and efficient with Sofia catheters. These devices achieved very high reperfusion rates with a low requirement for stent retriever rescue therapy, especially for M1 occlusions.
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Affiliation(s)
- G Marnat
- From the Interventional and Diagnostic Neuroradiology Department (G.M., X.B., F.G., J.B., P.M.), Bordeaux University Hospital, Bordeaux, France
| | - X Barreau
- From the Interventional and Diagnostic Neuroradiology Department (G.M., X.B., F.G., J.B., P.M.), Bordeaux University Hospital, Bordeaux, France
| | - L Detraz
- Interventional and Diagnostic Neuroradiology Department (L.D., R.B.), Nantes University Hospital, Nantes, France
| | - R Bourcier
- Interventional and Diagnostic Neuroradiology Department (L.D., R.B.), Nantes University Hospital, Nantes, France
- Interventional Neuroradiology Department (R.B.), Fondation Ophtalmologique Rothschild, Paris, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), University Hospital of Nancy, Nancy, France
- Institut National de la Santé et de la Recherche Médicale U1254 (B.G.), IADI F-54000, Nancy, France
| | - A Sgreccia
- Department of Radiology (A.S.), Ospedali Riuniti, Siena, Italy
| | - F Gariel
- From the Interventional and Diagnostic Neuroradiology Department (G.M., X.B., F.G., J.B., P.M.), Bordeaux University Hospital, Bordeaux, France
| | - J Berge
- From the Interventional and Diagnostic Neuroradiology Department (G.M., X.B., F.G., J.B., P.M.), Bordeaux University Hospital, Bordeaux, France
| | - P Menegon
- From the Interventional and Diagnostic Neuroradiology Department (G.M., X.B., F.G., J.B., P.M.), Bordeaux University Hospital, Bordeaux, France
| | - M Kyheng
- Université Lille (M.K., J.L.), Centre Hospitalier Universitaire Lille, Lille, France
| | - J Labreuche
- Université Lille (M.K., J.L.), Centre Hospitalier Universitaire Lille, Lille, France
| | - A Consoli
- Department of Neuroradiology (A.C.), Foch Hospital, Suresnes, France
| | - R Blanc
- From the Interventional and Diagnostic Neuroradiology Department (G.M., X.B., F.G., J.B., P.M.), Bordeaux University Hospital, Bordeaux, France
| | - B Lapergue
- Department of Neurology (B.L.), Stroke Center, Foch Hospital, Suresnes, France
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Martini M, Mocco J, Turk A, Siddiqui AH, Fiorella D, Hanel RA, Woodward K, Rai A, Frei D, Delgado Almandoz JE, Kelly ME, Peeling L, Arthur AS, Baxter B, English J, Linfante I, De Leacy R. 'Real-world' comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study. J Neurointerv Surg 2019; 11:957-963. [PMID: 30975738 DOI: 10.1136/neurintsurg-2018-014624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Thrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to 'real-world' practice. OBJECTIVE To compare revascularization rates and outcomes for direct aspiration (ADAPT) and stent retriever thrombectomy following anterior acute ischemic stroke (AIS) in a real-life setting. METHODS Data from the most recent 20 consecutive patients with AIS treated with mechanical thrombectomy between 2015 and 2016 were collected from 15 high-volume stroke centers across North America for a total of 300 cases. Patients with proximal anterior large vessel occlusions were dichotomized by primary treatment technique. Ordinal logistic regression assessed the effects of clinical variables on patient disability using 90-day modified Rankin Scale (mRS) scores. RESULTS Adequate revascularization (Thrombolysis in Cerebral Infarction ≥2b) was ultimately achieved in 91.2% of first-line direct aspiration (ADAPT) cases with an average of 1.9±1.9 passes and in 87.5% of stent retriever cases with an average of 1.7±1.0 passes. Time from groin puncture to revascularization was shorter for ADAPT cases. The mean 90-day mRS score for both groups was 3.0±2.4. Number of passes using primary technique, and postintervention intracranial hemorrhage, were significant predictors of 90-day mRS scores after ADAPT, while age and preprocedure mRS score were predictive of outcomes following first-line stent retriever. CONCLUSIONS Our data show similar adequate revascularization rates and 90-day functional outcomes for first-line direct aspiration and stent retrievers for anterior large vessel occlusion in a real-world setting. These results support the findings of other prospective trials evaluating the two techniques.
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Affiliation(s)
- Michael Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J Mocco
- The Mount Sinai Health System, New York, USA
| | - Aquilla Turk
- Department of Neurosurgery, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA.,SUNY SB, New York, USA
| | - Ricardo A Hanel
- Stroke and Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | | | - Ansaar Rai
- Department of Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Don Frei
- Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
| | | | - Michael E Kelly
- Royal University Hospital, University of Saskatchewan, Department of Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Lissa Peeling
- Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam S Arthur
- UT Dept Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Blaise Baxter
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Joey English
- Department of Neurology and Radiology, UCSF, San Francisco, California, USA
| | - Italo Linfante
- Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Tonetti DA, Desai SM, Casillo S, Zussman BM, Brown MW, Jadhav AP, Jankowitz BT, Jovin TG, Gross BA. Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy. J Neurointerv Surg 2019; 11:637-640. [PMID: 30733300 DOI: 10.1136/neurintsurg-2018-014633] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Various large-bore catheters can be employed for manual aspiration thrombectomy (MAT); clinical differences are rarely explored. METHODS Prospectively collected demographic, angiographic, and clinical data for patients with acute internal carotid artery, middle cerebral artery M1, or basilar occlusions undergoing MAT over 23 months at a comprehensive stroke center were reviewed. We excluded patients in stentriever-based randomized trials/registries. The four most commonly utilized aspiration catheters were analyzed, and multivariate logistic regression analyses were performed to determine the effect of primary aspiration catheter choice on first-pass success, final reperfusion, and modified Rankin Scale (mRS) score at 90 days. RESULTS Of 464 large vessel thrombectomies, 180 were performed via MAT on the first pass with one of four catheters. First-pass success was achieved in 42% of cases overall; this rate did not differ significantly between catheters: 50% for Sofia, 45% for CAT6, 40% for 0.072 inch Navien, and 36% for ACE68, p=0.67. Final Thrombolysis in Cerebral Infarction 2b or 3 reperfusion was achieved in 94% of cases overall: 97% of cases with CAT6, 95% with Sofia, 92% with Navien, and 92% with ACE68, p=0.70. Mean number of passes for index thrombus (2.0 overall), median procedure time (32 min overall), 90-day good outcome (mRS 0-2, mean 36%), and 90-day mortality (mean 27%) did not differ significantly between patients treated with different initial catheters. CONCLUSION Among large-bore aspiration catheters, catheter selection is not an independent predictor of first-pass success, final reperfusion, or clinical outcome.
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Affiliation(s)
- Daniel A Tonetti
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shashvat M Desai
- The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephanie Casillo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Benjamin M Zussman
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Merritt W Brown
- The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashutosh P Jadhav
- The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Thomas Jankowitz
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Arslanian RA, Marosfoi M, Caroff J, King RM, Raskett C, Puri AS, Gounis MJ, Chueh JY. Complete clot ingestion with cyclical ADAPT increases first-pass recanalization and reduces distal embolization. J Neurointerv Surg 2019; 11:931-936. [PMID: 30718384 DOI: 10.1136/neurintsurg-2018-014625] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Evidence is mounting that first-pass complete recanalization during mechanical thrombectomy is associated with better clinical outcomes in patients presenting with an emergent large vessel occlusion. We hypothesize that aspiration achieving complete clot ingestion results in higher first-pass successful recanalization with quantitative reduction in distal emboli. METHODS A patient-specific cerebrovascular replica was connected to a flow loop. Occlusion of the middle cerebral artery was achieved with clot analogs. Independent variables were the diameter of the aspiration catheter (0.054-0.088in) and aspiration pattern (static versus cyclical). Outcome measures were the first-pass rates of complete clot ingestion, the extent of recanalization, and the particle-size distribution of distal emboli. RESULTS All aspiration catheters were successfully navigated to the occlusion. Complete clot ingestion during aspiration thrombectomy resulted in first-pass complete recanalization in every experiment, only achieved in 21% of experiments with partial ingestion (P<0.0001). Aspiration through the large bore 0.088in device resulted in the highest rates of complete clot ingestion (90%). Cyclical aspiration (18-29 inHg, 0.5 Hz) significantly increased the rate of complete clot ingestion (OR21 [1.6, 266]; P=0.04). In all experiments, complete clot ingestion resulted in fewer and smaller distal emboli. CONCLUSIONS Complete clot ingestion results in fewer distal emboli and the highest rates of first-pass complete recanalization. The rate of complete ingestion during aspiration thrombectomy is a function of both the inner diameter of the aspiration catheter and use of cyclical aspiration.
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Affiliation(s)
- Rose A Arslanian
- Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Miklos Marosfoi
- Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jildaz Caroff
- Hôpital Beaujon, Department of Interventional Neuroradiology, Clichy, France
| | - Robert M King
- Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Christopher Raskett
- Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ju-Yu Chueh
- Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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