P-014 arts (ace-retriever technique for stroke): initial clinical experience

Abstract

Background The development of a new generation of highly navigable large bore aspiration catheters and retriever devices, dedicated to the revascularization of large intracranial vessel occlusions in the context of acute ischemic stroke (AIS), has improved recanalization rates and time, with significant impact on clinical outcomes. We report a retrospectively collected clinical data utilizing a new recanalization technique based on combined large lumen aspiration catheter and partially resheathed stent retrievers for thrombectomy (ARTS: ACE-Retriever Technique for Stroke). Methods A retrospective data analysis was performed to identify patients with acute ischemic stroke treated at our institution with ARTS for occluded large cerebral vessels recanalization. The study was conducted between July 2013 and October 2014 at a single high volume stroke center. Procedural and clinical data were captured for analysis, including recanalization rate, post-treatment National Institutes of Health Stroke Scale (NIHSS) score, symptomatic intracranial hemorrhage, discharge 90 day modified Rankin Scale (mRS) score, and mortality. Results 40 patients (average age of 64.5 years, range 90–20 years; 24 F:16 M) were found that met the inclusion criteria for this retrospective study. The ARTS was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 97.5% of cases (TICI 2b = 18 pts, TICI 3 = 21 pts). The average time from groin puncture to at least TICI 2b recanalization was 62 min. In patients with successful recanalization, admitted with median National Institutes of Health Stroke Scale (NIHSS) score of 16.7 (6.0–29.0), was observed a value improvement to a median NIHSS score at discharge of 3.4 (0–13.0). In eight patients (20%), the association of a carotid bifurcation severe stenosis/occlusion and intracranial large vessel occlusion (tandem lesions), required a carotid stent deployment along the cervical segment of the internal carotid artery. A 3 month follow-up Modified Rankin Scale (mRS) value of 0–2 was observed in 48.5% of the successfully treated patients (average 2.6). Two patients were lost to follow-up. No procedure related deaths were observed. Conclusions Mechanical thrombectomy utilizing combined 5 MAX ACE aspiration catheter and Stent Retrievers Technique for Stroke treatment (ARTS) is a fast, safe and effective method for endovascular recanalization of large vessel occlusions presenting within the context of AIS. Disclosures F. Massari: None. N. Henninger: None. J. Lozano: None. M. Howk: None. M. Perras: None. C. Brooks: None. M. Gounis: 1; C; NIH, Philips Healthcare, Covidien, Codman, Stryker, Wyss Institute, Tay Sachs Foundation. 2; C; Stryker (fee per hour). A. Wakhloo: 1; C; Philips Medical. 2; C; Stryker. 3; C; Harvard Postgraduate Course, Miami Baptist Vascular Institute. A. Puri: 1; C; Stryker. 2; C; Codman, Covidien.