E-093 first pass direct aspiration using intermediate catheters in acute major vessel occlusion stroke

Abstract

Introduction Mechanical thrombectomy is increasingly being shown to be an effective part of acute stroke treatment. There are a variety of techniques described to extract clot, most of them involving stent retrievers. These devices can be expensive, involve additional steps that increase the complexity of the procedure and require specialist operators. Direct aspiration of the clot can be an effective way to restore flow with fewer of these difficulties. We report our immediate clinical experience using an aspiration technique with a new generation of intermediate catheters. Materials and method From our institution’s prospective database, between March 2012 and June 2014 a total of 15 acute ischemic stroke patients with major vessel occlusion underwent mechanical thrombectomy for ischemic stroke using a first pass direct aspiration technique that utilized intermediate catheters. All procedural and clinical data were retrospectively analyzed for this study. Results The aspiration alone technique was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 10 out of the 15 cases (67%). The additional use of stent retrievers improved the overall TICI 2b/3 revascularization rate by only 1 patient (11 out of 15 (73%)). The average time from groin puncture to at least TICI 2b recanalization was 33.2 min. The Navien demonstrated similar success to the Sofia in achieving TICI 2b/3 revascularization alone. Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 15.5 (range 4–28) and improved to a median NIHSS score at discharge of 3.5 (range 0–28). There were 2 procedural complications and no symptomatic intracerebral hemorrhages. Conclusion Intermediate catheters allow fast, safe, simple and effective recanalization in acute ischemic stroke by utilizing the latest generation of large bore aspiration catheters with encouraging angiographic outcomes. We do not see direct aspiration substituting or excluding the use of stent retrievers, but they can be an initial fast and safe first attempt to recanalize the vessel. Disclosures M. Dumba: None. A. Carlton-Jones: None. A. Kar: None. M. Patel: None. K. Lobotesis: None.