Abstract WP206: Single Center Experience Using the 3-Max Catheter in Medium and Distal Vessel Occlusion

Abstract

Introduction: Stroke thrombectomy for medium and distal vessel occlusion is a topic of great interest with several clinical trials underway. We describe a single center experience with the Penumbra 3 max aspiration catheter in stroke thrombectomy. In our study, we compare the use of the 3 max as a de novo first pass catheter to its use as a rescue aspiration catheter following attempted thrombectomy with other devices. Methods: From January 2017 to January 2023, 84 patients underwent mechanical thrombectomy with use of a Penumbra 3 Max aspiration catheter at our comprehensive stroke center. Of these patients, 26 had 3 Max used as a first pass catheter (de novo) and 58 had it used on subsequent passes (rescue). We retrospectively reviewed these patient charts for demographic variables, and clinical and radiographic outcomes. We compared the effectiveness of the 3 Max catheter in achieving recanalization on first pass when used de novo, to the successful recanalization of a vessel when the 3 Max was used as a rescue device (“rescue rate”). Results: There were no significant differences in baseline demographic variables including age, gender, presenting NIHSS, and vascular risk factors between the de novo and rescue groups. There was no significant difference in location of occlusion and IV or IA thrombolytic use between the groups. The rescue rate was higher than the first pass effect [67.2% vs. 38.5%, X 2 (1, N =84) = 6.1, p<.05]. Rates of successful thrombectomy, defined as TICI2c or better, were similar between the de novo and rescue groups (44.4% vs. 40.4%, p=0.722). The de novo group had higher rates of favorable outcome at 90 days (mRS 0-2), but this did not reach statistical significance (44% vs. 28.1%, p=0.158). Hemorrhage and mortality rates between the two groups were low and not statistically significant when compared to each other. Conclusion: Medium and distal vessel occlusion carry high rates of morbidity and deserve consideration of endovascular therapy. The Penumbra 3 Max catheter has a higher rescue recanalization rate than first pass recanalization rate. It appears to be a safe and effective device when used in mechanical thrombectomy.