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Han N, Ma L, Xie Y, Xu G, Jia Y, Zhang N, Wang H. Application of Sofia Plus catheter tip shaping in the treatment of acute middle cerebral artery occlusion: A case control study. Medicine (Baltimore) 2023; 102:e35864. [PMID: 37960793 PMCID: PMC10637553 DOI: 10.1097/md.0000000000035864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023] Open
Abstract
To explore the safety and efficacy of Sofia Plus distal access catheter tip shaping for treatment of acute middle cerebral artery embolism. This single-center retrospective study involved patients eligible for acute embolic middle cerebral artery occlusion from January 2020 to October 2021. They were divided into a shaping and non-shaping group according to whether the Sofia Plus catheter tip was shaped intraoperatively. Baseline data, preoperative Alberta Stroke Program Early Computed Tomography (ASPECT) score, National Institutes of Health Stroke Scale (NIHSS) score, onset-to-admission time, admission-to-puncture time, Sofia Plus-clot time, puncture-to-reperfusion time, surgical approach, and use of a stent for rescue thrombectomy were compared between the 2 groups. Postoperative symptomatic intracerebral hemorrhage and the modified Rankin scale score at the 90-day follow-up were observed. In total, 54 patients were enrolled in this study (shaping group, 26 patients; non-shaping group, 28 patients). Their mean age was 64.8 ± 14.6 years, and the proportion of men was 68.5% (37/54). Successful recanalization was achieved in all patients. There were no differences in the baseline data (age, sex, history, pre-admission ASPECT score, or NIHSS score) between the shaping and non-shaping groups. Patients treated with a shaped Sofia Plus catheter had a shorter Sofia Plus-clot time [median (25th, 75th percentile: 4 (4, 7) vs 10.5 (5.25, 14) min, P = .006] and puncture-to-reperfusion time [16.5 (12, 30.5) vs 26 (16.25, 38.25) min, P = .036]. There were significant differences in the surgical approaches between the 2 groups. The rates of a favorable outcome (57.7% vs 64.3%, P = .62) and postoperative symptomatic intracerebral hemorrhage (7.7% vs 3.6%, P = .60) were not significantly different between the groups. Sofia Plus catheter tip shaping improved catheter trafficability and reduced the operative time. It was safe and effective for treatment of acute middle cerebral artery thrombotic occlusion.
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Affiliation(s)
- Ning Han
- Neurointerventional department, Hebei General Hospital, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China
| | - Liang Ma
- Neurointerventional department, Hebei General Hospital, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China
| | - Yanzhao Xie
- Neurointerventional department, Hebei General Hospital, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China
| | - Guodong Xu
- Neurointerventional department, Hebei General Hospital, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China
| | - Yangjuan Jia
- Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ning Zhang
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Hebo Wang
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China
- Neurology Department, Hebei General Hospital, Shijiazhuang, Hebei, China
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Schartz D, Ellens N, Kohli GS, Rahmani R, Akkipeddi SMK, Colby GP, Hui F, Bhalla T, Mattingly T, Bender MT. Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy. J Neurointerv Surg 2023; 15:e111-e116. [PMID: 35918126 DOI: 10.1136/jnis-2022-019246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Direct aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood. METHODS A systematic literature review and meta-regression analysis was completed to evaluate the impact of primary aspiration thrombectomy outcomes based on the ID of the aspiration catheter. Primary outcome measures were: final recanalization of modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3 with aspiration only and with rescue modalities, first pass effect (FPE), need for rescue modalities, intracranial hemorrhagic complication rates, and functional outcomes of 90-day modified Rankin Scale (mRS) of 0-2. RESULTS 30 studies were identified with 3228 patients. Meta-regression analysis revealed a significant association between increasing aspiration catheter ID and FPE (p=0.032), between ID and final recanalization with aspiration only (p=0.05), and between ID size and recanalization including cases with rescue modalities (p=0.002). Further, subgroup analysis indicated that catheters with an ID ≥0.064 inch had a lower rate of need for rescue than smaller catheters (p=0.013). Additionally, catheters with an ID ≥0.068 inch had a higher rate of intracranial bleeding complications (p=0.025). Lastly, no significant association was found in functional outcomes overall. CONCLUSIONS Larger aspiration catheters are associated with a higher rate of FPE, final recanalization with only an aspiration catheter, and in cases with rescue modalities, though with a higher rate of hemorrhagic complications. These findings confirm that aspiration catheter size functions as a variable in aspiration thrombectomy, which should be considered in future study and trial design.
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Affiliation(s)
- Derrek Schartz
- Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Nathaniel Ellens
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Redi Rahmani
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Ferdinand Hui
- Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
| | - Tarun Bhalla
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas Mattingly
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew T Bender
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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Munich SA, Saganty RS, Joshi KC, Radaideh Y. Evolution of Transradial Access for Mechanical Thrombectomy-A Single Center Experience. Neurosurgery 2023; 92:795-802. [PMID: 36512809 PMCID: PMC9988320 DOI: 10.1227/neu.0000000000002271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transradial access (TRA) recently has gained popularity among neurointerventionalists. However, hesitation to its use for mechanical thrombectomy (MT) remains. OBJECTIVE To evaluate and describe the evolution of TRA for MT. METHODS We performed a retrospective analysis of patients undergoing TRA for MT. We performed a chronological ternary analysis to assess the impact of experience. We assessed the impact of a guide catheter designed specifically for TRA. RESULTS We identified 53 patients who underwent TRA for MT. There was a statistically significant decrease in contrast use (148.9 vs 109.3 vs 115.2 cc), procedure time (62.4 vs 44.7 vs 41.3 minutes), fluoroscopy time (39.2 vs 44.7 vs 41.3 minutes), and puncture-to-recanalization time (40.6 vs 27.3 vs 29.4) over time. There was trend toward improved thrombolysis in cerebral infarction ≥ 2b recanalization rate (72.2% vs 77.8% vs 100%) over time. The introduction of a radial-specific catheter had a statistically significant positive impact on contrast use (133.8 vs 93 cc, P = .043), procedure time (54.2 vs 36.4 minutes, P = .003), fluoroscopy time (33.7 vs 19.8 minutes, P = .004), puncture-to-recanalization time (35.8 vs 25.1 minutes, P = .016), and thrombolysis in cerebral infarction ≥ 2b recanalization rate (71.4% vs 100%, P = .016). CONCLUSION TRA is a safe and effective route of endovascular access for MT. Experience with this technique improves its efficacy and efficiency. The introduction of a TRA-specific catheter expands the armamentarium of the neurointerventionalist and may facilitate lesion access during MT procedures. Continued development of radial-specific devices may further improve MT outcomes.
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Affiliation(s)
- Stephan A. Munich
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Ruth S. Saganty
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Krishna C. Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Yazan Radaideh
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
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