Effects of Intermediate Catheter Evolution on Technical Outcome of Mechanical Thrombectomy—A Comparison of the Performance of Two Distal Access Catheters in Mechanical Thrombectomy of Acute Ischemic Stroke

Comparison of clinical, technical, and safety outcomes between the Sofia 5Fr catheter vs. the Sofia 6Fr catheter; a MaSQ-Registry study

BACKGROUND

Direct aspiration during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients is safe and effective. The 'Soft torqueable catheter Optimized For Intracranial Access' (Sofia) catheter is commonly used. Data on differences between 5Fr and 6Fr Sofia is limited. Hence, we aimed to compare the clinical, technical, and safety outcomes between both Sofia catheters in AIS patients.

METHODS

Patients with an intracranial anterior circulation occlusion from the 'Maastricht Stroke Quality-registry' (MaSQ-registry), who underwent EVT for AIS from September 2020 to February 2023, and treated with the Sofia catheter in the first-line technique were included. Outcomes included a shift on the modified Rankin Scale (mRS) score at 90 days, favorable functional outcome (mRS 0-2), first-attempt recanalization rate, and per procedural complications. Multivariable regression analyses were performed with adjustments.

RESULTS

Out of 511 registered patients in the MaSQ-registry, 366 patients were included. 281 patients (77 %) were treated with the Sofia 6Fr. No shift towards better outcomes on the ordinal mRS score at 90 days was observed in the Sofia 6Fr group compared to the 5Fr (adjusted common[ac] OR:1.34, 95 %CI:0.70-2.56). Favorable functional outcome (aOR:1.24, 95 %CI:0.49-3.13), and per procedural complications (aOR:1.04, 95 %CI:0.41-2.64) did not differ significantly between Sofia 6Fr and 5Fr. The Sofia 6Fr achieved higher first-attempt successful recanalization rates (53 % versus 34 %; aOR:2.28, 95 %CI:1.11-4.69), and lower total thrombectomy attempts (median:1 versus 2; aβ:-0.63, 95 %CI:-1.21 to -0.05).

CONCLUSIONS

The use of 6Fr Sofia aspiration catheter leads in this single-center registry to higher first-attempt successful recanalization rates and fewer thrombectomy attempts compared to the 5Fr Sofia catheter. However, this did not reflect in better clinical outcomes.

Efficacy and safety of SOFIA aspiration catheter for mechanical thrombectomy via ADAPT and Solumbra echniques in acute ischemic stroke: A systematic review and meta-analysis

INTRODUCTION

SOFIA catheter is a relatively new and recently FDA-approved aspiration catheter. This systematic review aims to investigate the safety and efficacy of SOFIA catheter for treatment of acute ischemic stroke (AIS) via ADAPT and Solumbra techniques.

METHODS

Search of all studies evaluating the SOFIA catheter for mechanical thrombectomy (MT) for treatment of AIS via ADAPT and Solumbra techniques from inception through 2020 on Pubmed, PMC, and Embase was performed. We analyzed the angiographic and clinical outcomes of both techniques with SOFIA catheter using the random-effects model.

RESULTS

From 18 studies, 1836 patients were included with 1365 receiving MT using ADAPT and 471 with solumbra technique. The mean age was 69.8 years and 51.1% of the patients were women. The rate of rescue therapy was 30%. The outcomes rates of ADAPT group were as follows; mFPE (59.3%), FPE (34.4%) final TICI 2b/3 (89.3%), procedural complications (8%), embolization to new territory (ENT) (2.3%), symptomatic ICH (5.4%), mean NIHSS (8.97), 90-day-mRS 0-2 (48.8%), and mortality (15.3%). The outcomes rates of Solumbra group were as follows; mFPE (60.5%), FPE (46.7%), final TICI 2b/3 (93%), procedural complications (6.4%), ENT (2%), symptomatic ICH (6%), mean NIHSS (7.59), mRS 0-2 (53.8%), and mortality (10.8%). ICA and posterior circulation strokes, and tandem lesions had worse outcomes (P < .005). MCA strokes were associated with better outcomes (P = .005). ASPECT scores' association with the clinical outcomes was found statistically significant.

CONCLUSION

SOFIA catheter is effective and safe to treat acute ischemic stroke regardless of applied MT technique.

Efficacy and Safety of the Soft Torqueable Catheter Optimized For Intracranial Access in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis

OBJECTIVE

Acute ischemic stroke (AIS) is a severe, life-threatening type of stroke with poor prognosis and high recurrence rate, mainly attributed to large vessel occlusion (LVO). Improved understanding of the safety and effectiveness of the Soft Torqueable Catheter Optimized For Intracranial Access (SOFIA) for LVO-AIS might guide practitioners. Therefore, we conducted this study focusing on neurological outcomes, procedure-related complications, and recanalization rates.

METHODS

We collected data in January 2022 from PubMed, Cochrane, Web of Science, and Embase. The study considered that assessed the effects of the SOFIA catheter in treatment of LVO-AIS. We extracted data narratively and expressed the results with the proportions and 95% confidence intervals (CI).

RESULTS

We included 17 studies reporting on 2106 patients treated with the SOFIA catheter. The successful recanalization rate was 77% (95% CI, 71%-83%) with the SOFIA catheter alone and the application of a rescue stent-retriever was observed in 28% (95% CI, 23%-33%) of cases, resulting in an overall successful recanalization rate of 90% (95% CI, 87%-92%). A pooled estimate of 45% (95% CI, 39%-51%) was observed for functional independence at 90 days, 15% (95% CI, 11%-20%) for mortality at 90 days, and 5% (95% CI, 3%-8%) for symptomatic intracranial hemorrhage.

CONCLUSIONS

This meta-analysis revealed that aspiration thrombectomy with the SOFIA catheter is a safer and effective treatment modality for LVO-AIS.

MRS SOFIA: a multicenter retrospective study for use of Sofia for revascularization of acute ischemic stroke

BACKGROUND

Over the past several years there has been increased interest in the use of the Sofia aspiration system (MicroVention, Tustin, California) as a primary aspiration catheter.

OBJECTIVE

To perform a multicenter retrospective study examining the efficacy of the Sofia aspiration catheter as a standalone aspiration treatment for large vessel occlusion.

METHODS

Consecutive cases in which the Sofia catheter was used for aspiration thrombectomy for large vessel occlusion were included. Exclusion criteria were the following: (1) Sofia not used for first pass, and (2) a stent retriever used as an adjunct on the first pass. The primary outcome of the study was first pass recanalization (Thrombolysis in Cerebral Infarction (TICI) 2c/3). Secondary outcomes included first pass TICI 2b/3, crossover to other thrombectomy devices, number of passes, time from puncture to recanalization, and complications.

RESULTS

323 patients were included. First pass TICI 2c/3 was achieved in 49.8% of cases (161/323). First pass TICI 2b/3 was achieved in 69.7% (225/323) of cases. 74.8% had TICI 2b/3 with the Sofia alone. Crossover to other thrombectomy devices occurred in 29.1% of cases (94/323). The median number of passes was 1 (IQR=1-3). Median time from puncture to recanalization was 26 min (IQR=17-45). Procedure related complications occurred in 3.1% (10/323) of cases.

CONCLUSION

Our study highlights the potential advantage of the Sofia aspiration catheter for primary aspiration thrombectomy in acute ischemic stroke. High rates of first pass recanalization with low crossover rates to other thrombectomy devices were achieved. Median procedure time was low, as were procedural complications.