Efficacy of beveled tip aspiration catheter in mechanical thrombectomy for acute ischemic stroke

Neuroendovascular Rescue 2025: Trends in Stroke Endovascular Therapy

Neuroendovascular rescue of patients with acute ischemic stroke caused by a large arterial occlusion has evolved throughout the first quarter of the present century, and continues to do so. Starting with the intra-arterial instillation of thrombolytic agents via microcatheters to dissolve occluding thromboembolic material, the current status is one that includes a variety of different techniques such as direct aspiration of thrombus, removal by stent retriever, adjuvant techniques such as balloon angioplasty, stenting, and tactical intra-arterial instillation of thrombolytic agents in smaller branches to treat no-reflow phenomenon. The results have been consistently shown to benefit these patients, irrespective of whether they had already received intravenous tissue-type plasminogen activator or not. Improved imaging methods of patient selection and tactically optimized periprocedural care measures complement this dimension of the practice of neurointervention.

Assessment of the safety and efficacy of the Zoom 45 and 55 reperfusion catheters for medium and distal mechanical thrombectomies: A multi-institutional study

INTRODUCTION

The Zoom aspiration catheters harbor novel dimensions and construction to enhance trackability and deliverability. In addition, a beveled tip may improve thrombus interaction and aspiration force for a set inner diameter. This study evaluates their utility in medium and distal vessel occlusions.

OBJECTIVE

To evaluate the safety and efficacy of Zoom 45 and 55 aspiration catheters in medium and distal vessel thrombectomy.

METHODS

Patients treated for distal vessel occlusions via mechanical thrombectomy utilizing either the Zoom 45/55 catheter or a historical control catheter between 2021-2022 at two institutions were included in this study. Medium and distal occlusions were defined as any anterior or posterior cerebral artery branch as well as the M2-4 segment of the middle cerebral artery (MCA). Preprocedural, procedural, and postprocedural variables were obtained.

RESULTS

Thirty-eight patients underwent thrombectomy with Zoom 45 or 55 catheters; four had multiple occluded vessels. Occlusion location included the M2 in 32 cases, M3-4 in 7 cases, A2 in 2 cases and P2 in 1 case. The mean number of passes per occlusion was 1.6 and overall successful reperfusion (TICI 2b or greater) was achieved in 84 % of cases. There were no symptomatic procedure-related complications such as perforation or post-procedural symptomatic ICH. Modified Rankin scores rates of 0-2, 3-5, and 6 at three months post-procedure were 35.7 %, 21.4 %, and 42.9 %, respectively.

CONCLUSIONS

The Zoom beveled tip aspiration catheters are safe and effective for more challenging medium and distal vessel occlusions.

Use of angled-tip aspiration catheters is associated with a lower cost of thrombectomy in patients with acute ischemic stroke secondary to large and medium vessel occlusions

BACKGROUND

Recently, the angled-tip Zoom™ aspiration catheters were introduced. The tip is designed to improve suction force for clot retrieval. We evaluated the possibility of reducing procedure costs when using angled-tip catheters and compared the safety and angiographic effectiveness of angled-tip versus straight-tip catheters.

METHODS

We conducted a retrospective single-center cohort study involving patients with acute ischemic stroke due to large and medium vessel occlusions. The patients were divided into two groups: the post-Zoom group, in which angled-tip aspiration catheters were used and the pre-Zoom group, in which traditional straight-tip catheters were employed.

RESULTS

A total of 163 patients were included; 95 (58.3%) in the pre-Zoom group and 68 (41.7%) in the post-Zoom group. The groups were well-matched at entry. The post-Zoom group demonstrated a significant decrease in mean procedure cost ($9728 vs. $12,127; p = 0.002), shorter time to achieve modified thrombolysis in cerebral infarction ≥2b reperfusion (38.30 min vs. 53.26 min; p = 0.018), and shorter puncture to procedure completion time (46.42 min vs. 62.38 min; p = 0.022). Additionally, the mean procedural cost when using the ADAPT technique supported by the Zoom catheters was significantly lower than the Solumbra technique ($5754 ± $2806 vs. $13,498 ± $3244, p < 0.001). There were no differences in the rate of hemorrhage between the pre-Zoom group (17.9%) and the post-Zoom group (20.6%), p = 0.690.

CONCLUSION

The study demonstrated significant benefits, including cost reduction and shorter time to achieve reperfusion in patients treated with Zoom aspiration catheters. These findings support the use of angled-tip catheters in acute ischemic stroke management.

Case report: Utilization and efficacy of large-bore catheters in mechanical thrombectomies

Thrombotic strokes are caused by occlusion of flow in a blood vessel by a clot or thrombus, resulting in disruption of oxygen and nutrients to the brain that can result in neurological deficits. There are many devices now available for safe and effective removal of thrombi from large blood vessels. This report focuses on the Zoom 0.088" large-bore catheter, which has the potential to be navigated into a large vessel for thrombus removal via aspiration, and weigh the risks and benefits of its utilization in thrombectomy patients. In this case, we discuss the use of this device for thrombectomy of a left M1 middle cerebral artery occlusion that resulted in a distal left MCA dissection and eventual loss of access to the site of the thrombus. Ultimately, the patient died from a large stroke in the left MCA territory. In light of this occurrence, we seek to explore the utility and feasibility of large-bore catheters and their risks in thrombectomy candidates.

Mechanical thrombectomy with a novel beveled tip aspiration catheter: A technical case report

Recent data suggested aspiration thrombectomy as the first-pass approach in endovascular treatment of acute stroke and is accepted as a safe and efficient alternative to stent-retriever thrombectomy. The efficiency of mechanical thrombectomy for complete removal of the clot is directly related to the catheter trackability, aspiration force, and inner diameter of the aspiration catheter. Zoom 71 Aspiration catheter (Imperative Care, Campbell, California, USA) is a novel aspiration catheter with a beveled tip aiming to increase the tip surface area, increased suction force, and advanced trackability. This case report describes the successful use of Zoom 71 aspiration catheter in a left middle cerebral artery M2 branch occlusion and highlights technical details including navigation without the support of a microcatheter microwire combination.

Impact of Increasing Aspiration Catheter Size and Refinement of Technique: Experience of Over 1000 Strokes Treated With ADAPT

BACKGROUND

We present longitudinal data regarding the outcomes and evolution of mechanical thrombectomy (MT) using a direct aspiration first pass technique.

OBJECTIVE

To evaluate the impact of increasing aspiration catheter size.

METHODS

This is a planned analysis of a prospective cohort study that enrolled all patients who underwent a direct aspiration first pass technique MT in a comprehensive stroke center from January 2013 to December 2020. We did exploratory analysis of the characteristics and outcomes of patients who had intracranial internal carotid artery or M1 segment of middle cerebral artery occlusion based on the aspiration catheter bore size (small [041, 054, 058, and 060 inch] vs medium [0.064 and 0.068 inch] and medium vs large [0.071, 0.072, and 0.074 inch]).

RESULTS

During the 8-year study period, a total of 1004 patients were included. Median age was 69 years, 49% were female patients, and 60.6% were White. Symptomatic hemorrhagic transformation was observed in 47 patients (4.7%), and 366 patients (36.5%) achieved the modified Rankin scale of 0 to 2 at 90 days after the stroke. For patients with intracranial internal carotid artery or M1 occlusion, medium-bore aspiration catheters were more likely to achieve successful recanalization after first aspiration attempt (63.9% vs 51.4%, P = .015) and had a faster groin-to-reperfusion time (16 vs 20 minutes, P = .001) when compared with small-bore catheters. However, these differences were not significant when comparing medium-bore with large-bore catheters.

CONCLUSION

Medium-bore catheters had better performance measures compared with small-bore catheters. However, large-bore catheters did not show significantly better performance results that suggest a plateau effect.

Suction force rather than aspiration flow correlates with recanalization in hard clots: an in vitro study model

BACKGROUND

ANA Advanced Neurovascular Access provides a novel funnel component designed to reduce clot fragmentation and facilitate retrieval in combination with stent-retrievers (SRs) in stroke patients by restricting flow and limiting clot shaving. In previous publications ANA presented excellent in vitro/in vivo efficacy data, especially with fibrin-rich hard clots. We aimed to determine the main physical property responsible for these results, namely suction force versus aspiration flow.

METHODS

We evaluated in a bench model the suction force and flow generated by ANA and compared them to other neurovascular catheters combined with a SR (Solitaire). Aspiration flow was evaluated with a flow rate sensor while applying vacuum pressure with a pump. Suction force was determined using a tensile strength testing machine and a purposely designed tool that completely seals the device tip simulating complete occlusion by a hard clot. Suction force was defined as the force needed to separate the device from the clot under aspiration. All experiments were repeated five times, and mean values used for comparisons.

RESULTS

Aspiration flow increased with the inner diameter of the device: ANA 1.85±0.04 mL/s, ACE68 3.74±0.05 mL/s, and 8F-Flowgate2 5.96±0.30 mL/s (P<0.001). After introducing the SR, the flow was reduced by an average of 0.57±0.12 mL/s. Due to its larger distal surface, ANA suction force (1.69±0.40 N) was significantly higher than ACE68 (0.26±0.04 N) and 8F-Flowgate2 (0.42±0.06 N) (P<0.001). After introducing the SR, suction force variation was not relevant except for ANA that increased to 2.64±0.41 N.

CONCLUSION

Despite lower in vitro aspiration flow, the ANA design showed a substantially higher suction force than other thrombectomy devices.