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Knapen RRMM, Simon SR, Robbe MMQ, Jongkind J, Brans R, de Ridder IR, van Oostenbrugge RJ, van Zwam WH, van der Leij C. Comparison of clinical, technical, and safety outcomes between the Sofia 5Fr catheter vs. the Sofia 6Fr catheter; a MaSQ-Registry study. J Stroke Cerebrovasc Dis 2024; 33:107967. [PMID: 39187212 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107967] [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: 12/21/2023] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024] Open
Abstract
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.
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Affiliation(s)
- R R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - S R Simon
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - M M Q Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - J Jongkind
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - R Brans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - I R de Ridder
- Department of Neurology, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - R J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - W H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - C van der Leij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
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Grieb D, Meila D, Sommer CM, Schulz K, Abu-Fares O, Donnerstag F, Schlunz-Hendann M, Lanfermann H, Boxberg F. Feasibility and safety of ADAPT in acute distal posterior cerebral artery occlusions. Eur J Radiol 2023; 165:110936. [PMID: 37354767 DOI: 10.1016/j.ejrad.2023.110936] [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: 04/25/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVO) of the anterior circulation. Clinical experience with ADAPT in the distal posterior circulation, however, is still limited and published data is scarce. In this original work, feasibility, safety and efficacy of ADAPT with distal access catheters (DAC) for treatment of acute distal posterior cerebral artery occlusions (DPCAOs) is evaluated. METHOD All acute ischemic stroke patients between 2017 and 2022 with primary or secondary DPCAOs in the P2 or P3 segment, that underwent thrombectomy of the DPACO using ADAPT with DACs as frontline therapy, were identified. Demographic data, recanalization rates, procedural safety, and clinical outcome were assessed. RESULTS Twenty-four patients with primary (n = 6) or secondary (n = 18) DPCAOs (P2: 21/24; P3: 3/24) were included. Median NIHSS score at admission was 14.5 (IQR 9.5). In all cases, the DPCAO could be reached with the DAC. Successful revascularization (DMVO-p-TICI ≥ 2b) with ADAPT was achieved in 79.2% (19/24), including a first pass effect of 62.5% (15/24), leading to complete recanalization (DMVO-p-TICI 3). Median number of passes was 1 (range 1-2). No complications related to distal PCA aspiration thrombectomy occurred. Median NIHSS and mRS scores at discharge were 4 (IQR 8) and 3 (IQR 2), respectively. CONCLUSIONS ADAPT appears to be feasible, safe and effective for the treatment of acute DPCAOs in the setting of different occlusion patterns. High revascularization rates without procedural complications can be achieved. Further studies are needed to consolidate these results.
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Affiliation(s)
- Dominik Grieb
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany; Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany; Department of Diagnostic and Interventional Radiology, Helios Klinikum Krefeld, Krefeld, Germany
| | - Christof-Matthias Sommer
- Clinic of Neuroradiology, Stuttgart Clinics, Stuttgart, Germany; Clinic of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Schulz
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
| | - Omar Abu-Fares
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | - Frank Donnerstag
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | | | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
| | - Frederik Boxberg
- Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
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3
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Bernava G, Brina O, Reymond P, Rosi A, Hofmeister J, Yilmaz H, Muster M, Kulcsar Z, Lovblad KO, Machi P. In vitro evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter. Interv Neuroradiol 2022:15910199221135040. [PMID: 36348632 DOI: 10.1177/15910199221135040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Several variations of the combined thrombectomy technique for acute ischemic stroke using a stent retriever and aspiration catheter have been described. The aim of our study was to assess how the presence of the microcatheter and stent retriever affect the basic aspiration parameters, namely, flow rate and aspiration force, depending on their position within the aspiration catheter. METHODS Two experimental set-ups were designed to assess changes in flow rate and aspiration force according to the position of the stent retriever and microcatheter within the aspiration catheter. RESULTS The transition of the stent retriever and microcatheter from the distal to proximal position resulted in a progressive increase in the flow rate, but with no impact on aspiration force. Additionally, the size of the stent retriever had no significant effect on flow rate changes and the reduction in flow rate was related to the microcatheter diameter. Negative pressure generated inside the aspiration catheter impacted on its distal segment located beyond the radiopaque marker, thus leading to its partial collapse. As a consequence, the measured aspiration force was lower than the theoretical aspiration force level for all tested aspiration catheters. CONCLUSIONS In our experimental model, the position of the stent retriever and microcatheter within the aspirator catheter affected the flow rate, but not the aspiration force. Negative pressure generated within the aspiration catheter appeared to determine a partial collapse of the distal segment that resulted in a less effective aspiration force than the theoretical aspiration force level.
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Affiliation(s)
- Gianmarco Bernava
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Rosi
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jeremy Hofmeister
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Hasan Yilmaz
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Michel Muster
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Zsolt Kulcsar
- Division of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Karl-Olof Lovblad
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
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Chen F, Bai X, Hu W, Guo F, Chen J, Zhou Z, Chen Y, Gao P, Liu Y, Yang Q, Liu X, Xu Y, Chen H, Wang Y, Yang B, Dmytriw AA, Patel AB, Ma Q, Jiao L. A Prospective, Multicenter, Single-Group Target-Value Clinical Trial to Evaluate the Safety and Efficacy of a Large Bore Aspiration Catheter System for the Endovascular Treatment of Acute Ischemic Stroke. Front Neurol 2022; 13:864563. [PMID: 35756925 PMCID: PMC9218266 DOI: 10.3389/fneur.2022.864563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This study was conducted to determine the safety and efficacy of the Esperance® Distal Access Catheter (0.071”), a novel large bore aspiration catheter in treating acute ischemic stroke (AIS) with large vessel occlusion (LVO). Methods A prospective multicenter clinical trial involving 15 stroke centers was performed. Baseline characteristics, procedural data, and angiographic and clinical outcomes of all acute stroke procedures (from May 2020 to March 2021) using the novel large bore aspiration catheter were analyzed. Results During the study period, 160 consecutive patients were recruited. The mean age and median baseline NIHSS were 65.4 years and 16, respectively. Successful reperfusion was achieved in 147 (91.9%) cases [at least modified Thrombolysis in Cerebral Infarction (mTICI) 2b] with aspiration alone, with complete reperfusion (mTICI 3) in 94 (58.8%) cases. Successful/complete first pass reperfusion was achieved in 104 (64.60%) cases, including mTICI 2b in 34 (21.1%) cases and mTICI 3 in 70 (43.5%) cases. The time from groin puncture to successful reperfusion was 44 (33, 62) min. There were 16 (9.9%) cases requiring rescue therapy using stent-retriever. Procedure-related complications included 2 (1.3%) cases of arterial perforation, 2 (1.3%) cases of arterial dissection, 12 (7.5%) cases of distal embolization, and 1(0.6%) case of puncture site infection. The rate of symptomatic intracranial hemorrhage (sICH) was 3.8% and mortality rate was 13.8%. A total of 99 (62.3%) cases had a favorable outcome (mRS 0–2) at 90 days. Conclusions In current practice, the first-line aspiration approach with the Esperance® Distal Access Catheter is safe and efficacious. This device may achieve high reperfusion rates with lower instances of rescue stent retriever therapy.
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Affiliation(s)
- Fei Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Wei Hu
- Department of Neurology, Anhui Provincial Hospital, Anhui Medical University Hefei, Anhui, China
| | - Fuqiang Guo
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Yongchang Liu
- Department of Neurovascular Intervention, Cangzhou Central Hospital, Cangzhou, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xinfeng Liu
- Department of Neurology, Eastern Theater General Hospital of the Chinese People's Liberation Army, Nanjing, China
| | - Yun Xu
- Department of Neurology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huisheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Beijing, China
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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5
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Nam JW, Jung NY, Park ES, Kwon SC. Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience. J Korean Neurosurg Soc 2021; 64:732-739. [PMID: 34503313 PMCID: PMC8435647 DOI: 10.3340/jkns.2020.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/26/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Early successful reperfusion is associated with favorable outcomes in acute ischemic stroke (AIS). The purpose of this study was to achieve successful recanalization by a combined mechanical thrombectomy technique, the Aspiration-Retriever Technique for Stroke (ARTS), which is composed of a flexible large lumen distal access catheter and a retrievable stent as the first-line strategy of mechanical thrombectomy.
Methods We retrospectively reviewed 62 patients with AIS who underwent mechanical thrombectomy from 2018 to 2019 at our institute by a senior neurointerventionalist. Among them, patients who were treated using the ARTS technique with the soft torqueable catheter optimized for intracranial access (SOFIA®; MicroVention-Terumo, Tustin, CA, USA) as the first-line treatment were included. Patients who had tandem occlusions or underlying intracranial artery stenosis were excluded. The angiographic and clinical outcomes were evaluated. The angiographic outcome was analyzed by the rate of successful recanalization, defined as a Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all procedures and the rate of successfully achieving the first pass effect (FPE), defined as complete recanalization with a single pass of the device. The clinical outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), and mortality.
Results A total of 27 patients (mean age, 59.3 years) fulfilled the inclusion criteria. The successful recanalization rate was 96% (n=26) while the FPE rate was 41% (n=11). The mean post-procedural NIHSS change was -3.0. Thirteen patients (48%) showed good clinical outcomes after thrombectomy with the ARTS technique (mRS at 90 days ≤2). Postoperative complications occurred in seven of 25 patients : hemorrhagic transformation in six patients (22%) and distal embolization in one patient (4%). Mortality was 15% (n=4).
Conclusion Although the clinical outcomes using the ARTS technique with a flexible large lumen distal access catheter performed as the frontline thrombectomy in patients with AIS were not significantly superior than those of other studies, this study showed a high rate of successful endovascular recanalization which was comparable to that of other studies. Therefore, ARTS using the SOFIA® catheter can be considered as the first choice of treatment for AIS due to large vessel occlusion.
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Affiliation(s)
- Ji Won Nam
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Na Young Jung
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Suk Park
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurological Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Cortez GM, Turner RD, Monteiro A, Puri AS, Siddiqui AH, Mocco J, Vargas J, Kuhn AL, Majidi S, Chaudry MI, Aghaebrahim A, Turk AS, Sauvageau E, Hanel RA. Walrus large bore guide catheter impact on recanalization first pass effect and outcomes: the WICkED study. J Neurointerv Surg 2021; 14:280-285. [PMID: 33858971 DOI: 10.1136/neurintsurg-2021-017494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The use of a balloon-guide catheter (BGC) in acute stroke treatment has been widely adopted after demonstrating optimized procedure metrics and outcomes. Initial technical constraints of previous devices included catheter stiffness and smaller inner diameters. We aim to evaluate the performance and safety of the Walrus BGC, a variable stiffness catheter with a large bore 0.087 inch inner diameter (ID), via the the WICkED study (Walrus Large Bore guide Catheter Impact on reCanalization first pass Effect anD outcomes). METHODS This is a retrospective, site adjudicated, multicenter study on consecutive patients with large vessel occlusion treated with the Walrus BGC. Baseline characteristics, procedural outcomes and functional outcomes were analyzed. RESULTS A total of 338 patients met the inclusion criteria. The Walrus was successfully tracked into distal vasculature and allowed therapeutic device delivery in all but 3 cases (0.9%). Large aspiration catheters ≥0.070 inch ID were used in 71.9% of cases. Stent retriever thrombectomy was used as the first-line modality in 59.2% and thromboaspiration in 40.8% of cases. The successful recanalization rate (modified treatment in cerebral ischemia (mTICI) 2b/3) was 94.4%, with 64.8% of the patients achieving mTICI 2b/3 after the first pass. The Walrus-related adverse event rate was 0.6%, corresponding to two vessel dissections. Functional independence was 50% (126/252) and mortality 25% (63/252). Unfavorable outcomes were more likely in older patients, who had unsuccessful reperfusion, longer procedure times, and a higher mean number of passes. CONCLUSION In acute ischemic stroke patients presenting with large vessel occlusion, the Walrus BGC demonstrated excellent navigability and safety profile, allowed the accommodation of leading large bore aspiration catheters, and demonstrated high vessel recanalization rates.
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Affiliation(s)
- Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
- Research, Jacksonville University, Jacksonville, Florida, USA
| | - Raymond D Turner
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Andre Monteiro
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Ajit S Puri
- Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Adnan H Siddiqui
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jan Vargas
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Anna L Kuhn
- Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Shahram Majidi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Imran Chaudry
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Amin Aghaebrahim
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Aquilla S Turk
- Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
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