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Ikeda H, Ishibashi R, Kinosada M, Uezato M, Hata H, Kaneko R, Osuki T, Akaike N, Tanimura M, Torimaki S, Fujiwara T, Nishi R, Wada M, Yokochi Y, Hayashi T, Takada K, Kurosaki Y, Chin M, Yamagata S. Learning Curve Effect of Combined Technique Thrombectomy as First-Line Attempt for Acute Ischemic Stroke: A Single-Center Retrospective Study. World Neurosurg 2024:S1878-8750(24)00901-X. [PMID: 38810873 DOI: 10.1016/j.wneu.2024.05.138] [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: 11/12/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES We retrospectively examined the initial experience and learning curve after the introduction of thrombectomy with the combined technique using an aspiration catheter and a stent retriever as first-line attempt for acute ischemic stroke. METHODS Consecutive patients undergoing thrombectomy for acute ischemic stroke at our institution between January 2020 and December 2022 were divided into 3 groups according to the year of thrombectomy. Patient characteristics and procedural, safety, and clinical outcomes were compared between the three year periods to determine predictors of favorable clinical outcome. RESULTS In 2020, 2021, and 2022, the numbers of patients were 74, 70, and 90, respectively, with similar patient characteristics across the three years; successful recanalization rates were 79.7%, 97.1%, and 93.3%, respectively (P < 0.01 for the first 2 years); median procedure times were 67, 43, and 32 minutes, respectively (P < 0.01 for the first 2 years and P = 0.018 for the last 2 years); first pass effect rates were 20.3%, 41.4%, and 44.4%, respectively (P < 0.01 for the first 2 years); symptomatic intracranial hemorrhage rates were 14.9%, 2.9%, and 1.1%, respectively (P = 0.018 for the first 2 years); and percentages of modified Rankin Scale score 0-2 at 90 days were 24.3%, 42.9%, and 41.1%, respectively (P = 0.022 for the first 2 years). Procedure time (P = 0.038) and successful recanalization (P = 0.041) were independent predictors of favorable clinical outcome. CONCLUSIONS The learning curve effect of the combined technique may be associated with better clinical outcome due to increased successful recanalization rates, shortened procedure time, and reduced symptomatic intracranial hemorrhage.
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Affiliation(s)
- Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Ryota Ishibashi
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hidenobu Hata
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryosuke Kaneko
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takuya Osuki
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Natsuki Akaike
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Mai Tanimura
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shinya Torimaki
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshio Fujiwara
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryosuke Nishi
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Makoto Wada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasunori Yokochi
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tomoko Hayashi
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kensuke Takada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
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Requena M, Li J, Tiberi R, Canals P, Olive Gadea M, de Dios Lascuevas M, Jabłońska M, Cendrero J, Garcia-Tornel A, Tomasello A, Ribo M. Impact on collateral flow of devices used for endovascular treatment of stroke: an in-vitro flow model. J Neurointerv Surg 2023:jnis-2023-020602. [PMID: 37648434 DOI: 10.1136/jnis-2023-020602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Collateral blood supply of distal vessels has been linked to clinical outcome, infarct volume and recanalization rates in patients with large vessel occlusion. Our study aimed to explore the effects of catheterization during mechanical thrombectomy in collaterals. METHODS We quantified the flow diversion effect secondary to arterial occlusions in an in vitro model which was connected in a flow-loop setup with a saline reservoir and a pump supplying pulsatile flow. Clot analogs were embolized to the middle cerebral artery (MCA) M1 or M2 segments. We used the same model with a clamped anterior communicating artery (AComA) to simulate its absence. An ultrasound flow sensor was placed at the vessel of interest. Flow rates and pressures were evaluated according to the following catheter locations: baseline (1) before and (2) after the occlusion; (3) 8F guiding catheter at the internal carotid artery (ICA) bulb; (4) at the cavernous segment; (5) at the cavernous segment a 0.071" distal access catheter at proximal M1; (6) 8F balloon guide catheter inflated. RESULTS Collateral blood flow measured at distal anterior cerebral artery (ACA) (M1-MCA occlusion) and M2-MCA (M2-MCA occlusion) was progressively reduced as catheters were advanced through the ICA and MCA. In the lacking AComA model, the flow was further diminished as compared with the model with a patent AComA. CONCLUSION Our in vitro study showed a progressive reduction of collateral blood flow due to the advance of catheters during mechanical thrombectomy.
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Affiliation(s)
- Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jiahui Li
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Pere Canals
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Olive Gadea
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Magda Jabłońska
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Radiology, Gdanski Uniwersytet Medyczny, Gdansk, Poland
| | - Judith Cendrero
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alvaro Garcia-Tornel
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alejandro Tomasello
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain
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Settecase F, Kim WT, English JD. AXS Vecta 0.071-0.074 Inch Aspiration Catheters for Mechanical Thrombectomy: Case Series and Literature Review. Neurointervention 2023; 18:47-57. [PMID: 36328761 PMCID: PMC9986352 DOI: 10.5469/neuroint.2022.00283] [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: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Aspiration catheters are widely used for thrombectomy either alone or in combination with a stent-retriever, with a distal inner diameter and trackability keys to their success. In an illustrative case series, we report our clinical experience with AXS Vecta (Stryker Neurovascular, Fremont, CA, USA), available in both 0.071-inch and 0.074-inch distal inner diameters, including the first 2 Vecta 74 cases reported. A literature review on AXS Vecta is also provided. In our series, 9 thrombectomies were performed (Vecta 71: 2 M1, 5 M2 occlusions; Vecta 74: 1 M1 and 1 ICA-terminus occlusion). The AXS Vecta was successfully delivered to the target site in all cases. In 7 of 9 cases, the catheter was delivered over a Tenzing 7 delivery catheter (Route 92 Medical, San Mateo, CA, USA). For 2 of 9 combination approach cases, Vecta was delivered using the stent-retriever wire as a rail. The median improvement in NIHSS score during hospitalization was 9 (IQR 5-12). Successful mTICI 2C or 3 recanalization was achieved in 8 of 9 (89%) patients after a median 2 (IQR 1-2) passes. Our median groin-to-reperfusion time was 23 (IQR 12.5-32) minutes, with no procedural complications. Two previous clinical studies of a total of 29 patients treated with Vecta 71 reported successful mTICI 2b-3 recanalization in 89-90% of cases. The Median groin-to-reperfusion time was 30 minutes. Complications were seen in 2 of 29 (6.9%) cases (vessel perforation and/or intracerebral hemorrhage). These data support the efficacy, deliverability, and safety of AXS Vecta for mechanical thrombectomy.
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Affiliation(s)
- Fabio Settecase
- Neurointerventional Radiology, California Pacific Medical Center, San Francisco, CA, USA.,Neurointerventional Radiology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Warren T Kim
- Neurointerventional Radiology, California Pacific Medical Center, San Francisco, CA, USA.,Neurointerventional Radiology, Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - Joey D English
- Neurointerventional Radiology, California Pacific Medical Center, San Francisco, CA, USA.,Neurointerventional Radiology, Mills-Peninsula Medical Center, Burlingame, CA, USA
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Li J, Ribo M. REACT Aspiration Catheters: Clinical Experience and Technical Considerations. Neurointervention 2022; 17:70-77. [PMID: 35718472 PMCID: PMC9256469 DOI: 10.5469/neuroint.2022.00255] [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: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Aspiration catheters are widely used in mechanical thrombectomy procedures to treat acute ischemic stroke due to large vessel occlusion. The key performance requirements for aspiration catheters are ease of navigation and effective aspiration. In this work, we review the clinical experience and in vitro studies of REACT aspiration catheters (Medtronic, Minneapolis, MN, USA). In vitro experiments showed that REACT catheters exhibit solid performance in navigation and aspiration. Previous studies reported that the recanalization capacity of the aspiration catheters can be influenced by the devices’ inner diameter and tip distensibility, the catheter-to-vessel diameter ratio, the negative pressure delivered by the vacuum generator, the cyclical aspiration mode, the proximal flow arrest, and the angle of interaction between catheter and clot. REACT catheters can be navigated through the vasculature without any support from a microcatheter/ microwire in favorable anatomical configurations. In challenging situations, mostly encountered when crossing the ophthalmic segment of the internal carotid artery, the use of the stentriever anchoring technique or delivery assist catheter can facilitate the navigation. Three clinical studies reporting on 299 patients who underwent mechanical thrombectomy with REACT catheters were included in this review. Successful recanalization (modified treatment in cerebral ischemia score 2b–3) was achieved in 89–96% of cases, no procedural complications related to REACT catheters were reported, and functional independence (modified Rankin Scale 0–2) at 90-days was 24–36%. In vitro experimental evaluations and clinical studies support the safety and effectiveness of the REACT catheters.
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Affiliation(s)
- Jiahui Li
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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