Aspiration Catheter Research Articles

Accelerated aspiration with Q™ catheter: An in vitro study.

Thrombectomy in distal, medium vessels is a topic of increasing interest. To date, there are few in vitro studies focused on performance of ≤5F catheters in medium vessels. The purpose of this study is to compare the performance of the 3F, 4F, and 5F MIVI Neuroscience Q Catheters versus Penumbra 3F, 4F, and MicroVention Sofia 5F Catheters. Using in vitro methods, we assessed and compared the following parameters: aspiration flow rates, clot uncorking forces, impulse, and clot ingestion. For flow rate, each aspiration catheter was immersed in a cylindrical container. Flow rate at one second was used to calculate impulse. For clot uncorking force, the force required to disengage a catheter from a simulated clot was recorded. For ingestion, we measured time to ingest soft and medium stiffness synthetic clots. The measured flow rates without a stent retriever for the Q3, Q4, and Q5 catheters were 3.54 ml/s, 5.32 ml/s, and 6.87 ml/s. The measured flow rates without a stent retriever for the 3MAX, 4MAX, and 5F Sofia were 1.46 ml/s, 2.56 ml/s, and 1.73 ml/s. The impulse calculated for one second was 26 mNs for Q5 vs 9 mNs for Sofia 5, 35 mNs for Q4 vs 15 mNs for 4Max< and 35 mNs for Q3 vs 9 mNs for 3Max. The average system ingestion for Q was significantly faster than the competitive catheters. The Q catheters demonstrated higher flow rates, higher uncorking force, and faster complete clot ingestion than competitive catheters.

Thrombus aspiration in people living with HIV- a night mare for interventionist

Abstract Background Cardiovascular disease, particularly atherosclerosis, and its complications are a growing cause of morbidity and mortality among individuals living with human immunodeficiency virus (HIV) in the post-antiretroviral therapy era. The role of thrombus aspiration combined with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) within this population remains contentious. While PCI is the preferred strategy for immediate revascularization in acute STEMI, challenges persist, with about 30% of patients experiencing persistent chest pain and ST-segment elevation despite achieving TIMI III flow in the culprit vessel. Methods We conducted a prospective observational study spanning from January 2015 to September 2023, involving ten consecutive HIV-infected patients presenting with STEMI to our acute coronary care unit. The study encompassed an analysis of baseline clinical characteristics, response to fibrinolytic therapy, angiographic findings, thrombus aspiration using the Export Aspiration Catheter, and the outcomes of percutaneous coronary intervention (PCI). Patients were closely monitored for in-hospital outcomes and followed up for five years, during which they received adjuvant highly active antiretroviral therapy (HAART). Results The mean age of the patients was 46 years, lower than their uninfected counterparts. Most patients presented with a lower Killip class, indicating favorable outcomes. CD4 count distribution showed variability, with ten patients undergoing rescue angioplasty with thrombus aspiration using the Export Catheter. The cohort was followed for five years, receiving consistent HAART therapy. Conclusion HIV-associated atherosclerosis presents a considerable health burden, characterized by distinctive non-calcified and inflammatory plaques vulnerable to rupture. Thrombus aspiration during PCI emerged as a valuable strategy, reducing thrombotic burden and contributing to improved clinical outcomes in people living with HIV.

The Prognostic Value of a Naples Score in Determining in-Hospital Mortality in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment

Background/Objectives: The Naples prognostic score (NPS), reflecting inflammation and nutritional status, has prognostic value, especially in cancer. This study evaluated its ability to predict in-hospital mortality in acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). Methods: We retrospectively studied 244 patients with AIS who were admitted between April 2020 and December 2023. Patients were included if they presented within 6 h of symptom onset with evidence of intracranial proximal arterial occlusion. The EVT was performed using aspiration catheters, stent retrievers, or both. The NPS was calculated based on the neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, and albumin and total cholesterol levels. Results: We found a significant association between higher NPS scores and in-hospital mortality. Patients with a high NPS (3 or 4) had a mortality rate of 41.6% compared to 21.0% in the low-NPS group (0, 1, or 2). The full model incorporating NPS showed superior predictive ability for in-hospital mortality compared with the baseline model (areas under the curve 0.881 vs. 0.808). A receiver-operating characteristic analysis at a cutoff of &gt;2.5 for the NPS showed a sensitivity of 86.6% and specificity of 41.9%. This study demonstrated that incorporating the NPS into the predictive model improved the accuracy and calibration for predicting in-hospital mortality. A decision curve analysis showed the net benefit of using the full model incorporating NPS over the baseline model, emphasizing its potential clinical application in prognostication. Conclusions: NPS is a reliable predictor of in-hospital mortality in AIS patients undergoing EVT. Incorporating NPS into clinical practice could help to identify high-risk patients and improve outcomes through tailored interventions.

Mechanical thrombectomy for internal carotid artery occlusion beyond a large paraclinoid aneurysm

BackgroundWith the launch of mechanical thrombectomy (MT), the prognosis of patients with cerebral infarction associated with large-vessel occlusion has improved. However, good outcomes are still not achieved in a few patients because of technical difficulties.Case presentationA 79-year-old Japanese woman was admitted with sudden-onset left hemiplegia. Tissue plasminogen activator was administered and MT was performed for internal carotid artery occlusion distal to a large paraclinoid aneurysm. Some technical difficulties were unique, including contrast agent retention, difficulty in guiding the system, and avoidance of rupture of the aneurysm. Here, we discuss the technical issues and solutions of the MT procedure employed in this case.ConclusionsThe procedure used in flow-diverter devices should be referenced and a stent-retrieving into an aspiration catheter with proximal balloon technique may be the most appropriate method.

Acute middle cerebral artery occlusion due to a small internal carotid aneurysm cavity with blood stagnation: illustrative case.

In cerebral large vessel occlusion, even when an aneurysm is close to the target vessel, if the aneurysm is relatively small and angiography shows no thrombus within the aneurysm, it is difficult to identify the aneurysm as the embolic source. A 67-year-old man with a history of two left-sided cerebral infarctions developed a small left-sided cerebral infarction. On hospital day 3, he developed a left M2 occlusion and underwent thrombectomy with retraction of a stent retriever into an aspiration catheter at the proximal end of the thrombus. A red thrombus was retrieved, and M2 recanalization was successfully achieved. Angiography revealed a large partially thrombotic aneurysm with a small cavity with blood stagnation in the left cervical internal carotid artery, which was considered the embolic source. Stent-assisted coil embolization was performed on the aneurysm, and no recurrent cerebral infarction was observed after embolization. In cerebral large vessel occlusion, an aneurysm cavity with blood stagnation may be the embolic source. Using an aspiration catheter alone or retracting a stent retriever into an aspiration catheter could be a useful technique and help to avoid interference between the aneurysm and the stent retriever. https://thejns.org/doi/10.3171/CASE24406.

Zoom71 Navigation: Does tip orientation matter?

BackgroundAspiration thrombectomy is one of the mainstays for stroke interventions. The Zoom 71 (Z71) aspiration catheter is unique with its angled tip. This study describes the orientation of the angled tip as it is navigated around the carotid siphon in relation to trackability. MethodProspectively collected cases involving large vessel occlusions of the anterior circulation intervened upon using the Z71 were retrospectively analyzed. 71 passes in 50 patients were analyzed with respect to Z71 tip orientation. 3 anatomical “turns” were defined as follows: “1”: proximal cavernous, “2”- ophthalmic turn, and “3”-ICA terminus to M1. The tip was described as “Toward” Vs “Away” with respect to the inner curve of each turn. The tip getting “caught” was also analyzed. ResultsThere was no preferential angled tip orientation of the Z71 as it was navigated around “Turn 1”, 51% “Away” vs 44% “Toward”, p= 0.54; “2”, 46.5% “Away” vs 53.5% “Toward”, p= 0.55; and “3”, 43.7% “Away” vs 46.5% “Toward”, p=0.63. The tip was not caught in Turn 1. It was caught up in “2” in 15.5% of passes. “Away” at “2” got caught up in 21% of passes vs 10.5% for “Toward”, p= 0.22. Z71 got caught up in “3” in 4.7% of passes. “Away” was associated with getting caught in 6.5% of passes vs 3% for “Toward”, p=0.52. Zoom 88 (Z88) usage as guide catheter may be associated with Z71 getting caught less in “2” compared to “Others”, 9.3% for Z88 vs 25%, p= 0.07. This also applied to Turn 3, 0% for Z88 vs 11.1%, p=0.038. ConclusionThere is no preferential angled tip orientation of the Z71 as it navigates around the carotid siphon. The tip orientation does not appear to significantly affect navigation. Usage of Z88 as guide catheter helps with Z71 trackability around the siphon.

Cyclic Aspiration in Mechanical Thrombectomy: Influencing Factors and Experimental Validation.

Mechanical thrombectomy is a fundamental intervention for acute ischemic stroke treatment. While conventional techniques are effective, cyclic aspiration (CyA) shows potential for better recanalization rates. We aim to investigate factors affecting CyA and compare them with static aspiration (StA). StA setup consisted of an aspiration pump connected to pressure transducer. CyA was tested with 5 subsequent iterations: single solenoid valve with air plus saline (i1) or saline alone (i2) as aspiration medium; 2 solenoid valves with air plus saline (i3) as aspiration medium; complete air removal and saline feeding (i4); and pressurized saline feeding (i5). To assess the efficacy of clot ingestion, the pressure transducer was replaced with a distal aspiration catheter. Moderately stiff clot analogs (15 mm) were used to investigate the ingestion quantified as clot relative weight loss. Additionally, the aspiration flow rate was assessed for each setup. With CyA i1, the amplitude of the achieved negative pressure waves declined with increasing frequencies but progressively increased with each subsequent iteration, achieving a maximum amplitude of 81 kPa for i5 at 1 Hz. Relative clot weight loss was significantly higher with i5 at 5 Hz than with StA (100% versus 37.8%; P = .05). Aspiration flow rate was lower with CyA than with StA (i5 at 5 Hz: 199.8 mL/min versus StA: 311 mL/min; P < .01). CyA with the appropriate setup may represent an encouraging innovation in mechanical thrombectomy, offering a promising pathway for improving efficacy in clot ingestion and recanalization. The observed benefits warrant confirmation in a clinical setting.

Safety and effectiveness of SOFIA/SOFIA PLUS for direct aspiration as first line treatment in patients with acute anterior ischemic stroke: results from the prospective, multicentric SESAME study.

Mechanical thrombectomy is a cornerstone treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO), yet the optimal technique remains debated. The SOFIA/SOFIA PLUS catheter has emerged as a promising tool for direct aspiration thrombectomy. This prospective multi-center study, adhering Good-Clinical-Practice guidelines, aimed to evaluate the safety and efficacy of the SOFIA/SOFIA PLUS catheter for direct aspiration as a first-line treatment technique in patients with acute anterior circulation LVO. Between 10/2017 and 12/2021, 246 consecutive patients presenting with AIS due to anterior circulation LVO were enrolled from 14 European centers. Primary treatment with SOFIA catheters was performed within 6 h of symptom onset. Clinical and radiological data were collected, and statistical analyses were conducted. The mean age of the included patients was 71.6 ± 13.9 years, with 44.7% being male. Primary aspiration achieved complete recanalization in 72.8% of patients, with functional independence observed in 63.8% after 90 days. Secondary outcomes included a median NIHSS of 4 at 24 h post-procedure, median ASPECTS of 7 on follow-up imaging, and a mortality rate of 24.4% at 90 days. No device malfunctions were observed, and the rate of symptomatic intracranial hemorrhage was 4.4%. Primary aspiration with the SOFIA/SOFIA PLUS catheter demonstrates favorable safety and efficacy profiles in the treatment of anterior circulation LVO. These findings support the utilization of this technique as a first-line approach in mechanical thrombectomy for AIS, contributing to the growing body of evidence endorsing the effectiveness of direct aspiration thrombectomy in stroke management.

Cardiac Output Directly Influences Intracardiac Air After Venous Air Embolism: An Echocardiographic Model Comparing Position Change on Intracardiac Air Bubble Clearance.

Venous air embolism (VAE) can cause significant morbidity and mortality. Prevention and management of VAE include cessation of air entrainment, positioning changes, and hemodynamic support. The degree to which position change and cardiac output (CO) moderate resolution of intracardiac air has not been rigorously studied using contemporary transesophageal echocardiography (TEE). This observational cohort-type study aimed to identify the effect of supine vs sitting positioning on the movement and resolution of intracardiac air. In 20 patients undergoing seated neurosurgery, central venous air aspiration catheters were placed through the median basilic vein. TEE was used to estimate the time required for clearance of agitated microbubbles from the right atrium and ventricle in both the supine and sitting position. Estimates of CO were also obtained echocardiographically in each position. Average clearance time was faster in the sitting vs the supine position with no significant difference in CO. A negative correlation between CO and right atrial clearance time across all patients was demonstrated with a Pearson coefficient of -0.4 (95% CI -0.07, -0.65) with P = .02. During VAE, both patient position and CO can significantly affect how bubbles move through intracardiac chambers. However, augmenting CO during VAE may be clinically more feasible, efficient, and productive than changing positioning-especially during crises unless the changing in position is intended to halt the entrainment of air. Further TEE studies of intravascular air movement affected by other position changes (lateral, reverse Trendelenburg) and vasopressors should be considered.

A prospective, randomized, controlled, interventional clinical trial to evaluate the safety and efficacy of the medical monopoint reperfusion system for aspiration thrombectomy in acute ischemic stroke patients (SUMMIT MAX): Trial rationale and design.

Treatment of large vessel occlusion (LVO) using mechanical thrombectomy with or without intravenous thrombolysis has demonstrated better outcomes compared to medical treatment alone. Large-bore aspiration catheters have been recently introduced. Their effectiveness and safety have not been demonstrated in a randomized trial. The SUMMIT MAX study is designed to address this question. SUMMIT MAX is a randomized controlled trial where the effectiveness and safety of the large-bore Monopoint Reperfusion system (Route 92 Medical, San Mateo, CA), will be compared to the currently largest available FDA-cleared aspiration thrombectomy device the AXS Vecta Aspiration system (Stryker Neurovascular, Fremont, CA). The study is a multi-center, prospective, randomized, controlled, interventional, open label clinical trial. The hypothesis is that the effectiveness measured by the recanalization rate (modified thrombolysis in cerebrovascular infarction - mTICI) and safety measured by symptomatic intracranial hemorrhage rate (sICH) of the medical monopoint reperfusion system is non-inferior to the AXS Vecta Aspiration system. Up to 250 subjects are enrolled with at least 50% of subjects enrolled by US sites. The primary effectiveness endpoint is successful arterial revascularization defined as an mTICI score ≥ 2b after use of the assigned device adjudicated by an independent core lab. The primary safety endpoint is defined as sICH within 24 h (-8/+24) post-procedure. Secondary endpoints include successful arterial revascularization defined as a mTICI score ≥ 2b after use of the assigned device with or without adjunctive therapy; device-related serious adverse events; all asymptomatic hemorrhages; time from groin puncture to final angiogram; and rate of first pass effect defined as mTICI 2b after first pass with the assigned device stratified by age (≤85, ≥ 86). SUMMIT MAX is a randomized controlled trial comparing the effectiveness and safety of a new large bore class of aspiration devices to the currently largest FDA-cleared aspiration device available.

An Alternative Side Puncture Technique for Aspiration Catheters in Mechanical Thrombectomy

Length mismatch between the aspiration catheters and microcatheters can hinder optimal thrombus engagement, particularly in tortuous vessels and cases of vascular stenosis. We present a case in which a side puncture technique was employed to deploy the stent retriever when exchangeable devices is unavailable. A man in his seventies with basilar artery occlusion underwent mechanical thrombectomy. The aspiration catheter failed to advance due to the tortuosity of the vertebral artery, preventing the microcatheter from delivering the stent retriever distal to the thrombus. By puncturing the aspiration catheter, additional microcatheter length was obtained, allowing the stent to be deployed at the targeted site. Thrombus extraction was then successfully performed using the Solumbra technique. This approach is advantageous for its simplicity and eliminates the need for additional devices. However, it also has specific drawbacks, such as damaging the aspiration catheters.

An in-vitro method for comparative analysis of aspiration catheter tracking performance.

Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) relies on efficient tracking of aspiration catheters through complex vascular anatomies. Differences in catheter design lead to variation in tracking performance which may only become apparent after use in patients. We developed an in-vitro methodology for evaluating aspiration catheter performance under a variety of pre-defined circumstances, that can be used during catheter development for design optimization. Validation of the in-vitro methodology involved testing four large bore aspiration catheters on recreated challenging vascular access routes derived from patient angiograms. Two experienced neurointerventionalists conducted the tests under controlled physiological and procedural conditions. Each catheter design was evaluated across 30 unique anatomy-procedural set-up combinations. A fifth, prototype large bore catheter was evaluated by trained engineers to assess the applicability of the in-vitro test. Results from statistical analysis using a general linear model demonstrated the methodology's effectiveness in detecting significant tracking differences among catheter designs (p < 0.01). Minimal inter-operator variability was observed (p = 0.304), while procedural techniques significantly influenced tracking performance (p < 0.01). The tortuosity of the arterial access route notably impacted catheter performance (p < 0.01), with anatomical features revealing varying degrees of influence on desirable and undesirable catheter design aspects. We successfully developed a test methodology for evaluating the trackability of large bore aspiration catheters intended for treating acute ischemic stroke with large vessel occlusions. This methodology offers a robust approach to pre-clinical design assessment, utilizing anatomical models that simulate real-world vascular challenges to enhance catheter optimization.

Combining the deployment of only the distal basket segment of the EMBOTRAP III and an aspiration catheter for M2 occlusions: the ONE-SEG technique.

Endovascular therapy (EVT) for distal medium vessel occlusions requires prioritizing effectiveness and safety. We developed a technique combining the deployment of only the distal basket segment of the EMBOTRAP III and an aspiration catheter (AC) for M2 occlusions, called the "ONE-SEG technique," and evaluated its clinical and technical impacts. This was a retrospective review of 30 consecutive patients with M2 segment middle cerebral artery occlusion treated using the ONE-SEG technique. This method involves deploying the EMBOTRAP III through a microcatheter in only one segment and guiding the AC to the M2 origin or distal M1. The rates of final-pass expanded thrombolysis in cerebral infarction (eTICI) scores of 2c/3 or 2b/2c/3, safety (symptomatic intracranial hemorrhage [sICH]), and clinical outcomes (modified Rankin Scale [mRS] score 0-2, 0-3 at 90 days, and mortality at 90 days) were evaluated. Of the 30 cases, 36.7% were female, and the mean age was 75.6 ± 11.0 years. The ONE-SEG technique was used for 17 cases (56.7%, median NIHSS 10 [5-15.5]) with primary M2 occlusion and 13 cases (43.3%, median NIHSS 20 [14-22.5]) with secondary M2 occlusion after proximal thrombus removal. The successful final reperfusion rate (eTICI 2b/2c/3) was 90% overall (27/30 cases). One case (3.3%) developed sICH with secondary M2 occlusion. At 3 months, mRS scores 0-2 were seen in 64.7% of patients with primary M2 occlusion (11/17 cases) and in 23.1% (3/13 cases) with secondary M2 occlusion. EVT using the ONE-SEG technique appears to be safe and effective for M2 occlusion.

Comparison of clinical, technical, and safety outcomes between the Sofia 5Fr catheter vs. the Sofia 6Fr catheter; a MaSQ-Registry study

BackgroundDirect aspiration during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients is safe and effective. The ‘Soft torqueable catheter Optimized For Intracranial Access’ (Sofia) catheter is commonly used. Data on differences between 5Fr and 6Fr Sofia is limited. Hence, we aimed to compare the clinical, technical, and safety outcomes between both Sofia catheters in AIS patients. MethodsPatients with an intracranial anterior circulation occlusion from the ‘Maastricht Stroke Quality-registry’ (MaSQ-registry), who underwent EVT for AIS from September 2020 to February 2023, and treated with the Sofia catheter in the first-line technique were included. Outcomes included a shift on the modified Rankin Scale (mRS) score at 90 days, favorable functional outcome (mRS 0-2), first-attempt recanalization rate, and per procedural complications. Multivariable regression analyses were performed with adjustments. ResultsOut of 511 registered patients in the MaSQ-registry, 366 patients were included. 281 patients (77 %) were treated with the Sofia 6Fr. No shift towards better outcomes on the ordinal mRS score at 90 days was observed in the Sofia 6Fr group compared to the 5Fr (adjusted common[ac] OR:1.34, 95 %CI:0.70–2.56). Favorable functional outcome (aOR:1.24, 95 %CI:0.49–3.13), and per procedural complications (aOR:1.04, 95 %CI:0.41–2.64) did not differ significantly between Sofia 6Fr and 5Fr. The Sofia 6Fr achieved higher first-attempt successful recanalization rates (53 % versus 34 %; aOR:2.28, 95 %CI:1.11–4.69), and lower total thrombectomy attempts (median:1 versus 2; aβ:–0.63, 95 %CI:–1.21 to –0.05). ConclusionsThe use of 6Fr Sofia aspiration catheter leads in this single-center registry to higher first-attempt successful recanalization rates and fewer thrombectomy attempts compared to the 5Fr Sofia catheter. However, this did not reflect in better clinical outcomes.

Optimizing thrombectomy in medium vessel occlusion: Focus on vessel diameter.

Mechanical thrombectomy for medium vessel occlusion (MeVO) is a challenging field with limited results. In this study, we aimed at evaluating the efficacy and safety of a procedural strategy beginning with occluded vessel diameter measurement and matched aspiration catheter selection. We retrospectively analyzed all sequentially treated patients by mechanical thrombectomy at two comprehensive stroke centers between May 2020 and April 2023, focusing on the occluded vessel diameter. We included patients who underwent thrombectomy for MeVO based on the matching strategy (a procedural approach involving vessel diameter assessment, matching aspiration catheter selection, and firm clot engagement with or without a stent retriever). We evaluated efficacy and safety using the modified Thrombolysis in the Cerebral Infarction Scale (mTICI) and intracranial hemorrhage (ICH) and procedure-related complications. Seventy patients fulfilled the final inclusion criteria. The median occluded vessel diameter was 1.71 mm. We achieved mTICI 2b/2c/3 in 82.9% and mTICI 2c/3 in 51.4% of the cases and did not observe any symptomatic ICH. We detected asymptomatic subarachnoid hemorrhage (SAH) in 24.3% of the cases, that is, 5.6%, 20.0%, and 45.5% in the vessel diameter groups ≥2.0, 1.5-2.0, and ≤1.5 mm, respectively. The SAH incidence was significantly higher in narrower vessel groups. The occluded vessel diameter and the contact method with clots predicted clinical outcomes. Matching strategy-based thrombectomy yields acceptable efficiency and safety results. In narrower vessels, it is optimal to engage matched aspiration catheters and clots without the assistance of conventional stent retrievers.

Narrative review of latest research progress about robotic percutaneous coronary intervention.

Robotic percutaneous coronary intervention (R-PCI) is a novel technology in which operators can manipulate guidewires and catheter devices in interventional cardiology. This approach provides great benefits to interventional cardiologists in terms of reducing both radiation exposure and orthopedic injuries. Several large, high-quality cohort studies have confirmed the short-term safety and high technical success rate of R-PCI. However, randomized long-term data are still needed before adopting them as part of standard coronary interventions. Furthermore, tele-stenting for complex coronary lesions has significant potential for R-PCI. We need to overcome the present relevant challenges for its application such as inherent delays, bedside care for unstable patients from R-PCIs to manual PCIs (M-PCIs), incompatibility for a thrombus aspiration catheter and heavily calcified lesions. There is a great future in laboratory workflow teams, 3D-printed anatomical models and multiple joint collaborative control algorithms. This narrative review summarizes the latest developments in R-PCI, with a focus on developments in robotic technology, and discusses the current and future potential use of R-PCI in clinical practice globally.

Feasibility, efficacy, and safety of mechanical thrombectomy via sheathless transradial access as a first-line strategy: A case series

ObjectiveAlthough mechanical thrombectomy (MT) is primarily performed via transfemoral access (TFA), transradial access (TRA) is a potential alternative in older patients or those with tortuous vessels. However, the small radial artery diameter restricts the use of large-bore balloon guides and aspiration catheters, a limitation that may be overcome using the sheathless technique. Thus, we aimed to explore the feasibility, efficacy, and safety of sheathless TRA-MT as a first-line treatment approach for acute ischemic stroke. MethodsThis single-center retrospective case series included patients who underwent TRA-MT as first-line treatment between September 2020 and June 2023. Per our MT protocol, TRA was not the first-line approach in cases of left anterior circulation lesions with a type 3 aortic arch. We evaluated treatment effectiveness based on the successful recanalization rate, puncture-to-recanalization time, and modified first-pass effect; access route effectiveness based on the puncture-to-first-pass time and switch-to-TFA rate; and procedure safety based on procedure-related and severe puncture site complications. ResultsSheathless 8-F guide catheters were used in 68 % and large-bore aspiration catheters in 70 % of the procedures. Successful recanalization was achieved in 98 % of the patients, with a modified first-pass effect in 54 % of them. The median puncture-to-first-pass and puncture-to-recanalization times were 20.5 and 33 min, respectively. The rate of procedure-related complications was low (4 %), with no severe puncture site complications. ConclusionSheathless TRA-MT enabled the use of large-bore guide and aspiration catheters, providing a swift approach to the target and satisfactory outcomes, and might be an effective first-line treatment for acute ischemic stroke.

Medium vessel occlusion thrombectomy: Single center experience using the 3 MAX catheter.

Thrombectomy for medium vessel occlusion is a topic of great interest. We describe a single-center experience with the Penumbra 3-MAX aspiration catheter in stroke thrombectomy of medium vessel occlusion(MeVO). We investigated the use of 3-MAX as a de-novo first pass catheter and as a rescue aspiration device following attempted thrombectomy with other devices. This is the first description of the first pass effect and successful recanalization rate of the 3-MAX catheter in de-novo vs. rescue use of this catheter. From January 2017 to January 2023, 84 patients underwent mechanical thrombectomy with use of a Penumbra 3MAX aspiration catheter at our comprehensive stroke center. Patient charts were retrospectively reviewed. Primary efficacy outcome was successful recanalization following mechanical thrombectomy. Primary safety outcome was intracerebral hemorrhage. A total of 84 patients underwent MT with the 3MAX device. It was used as a de novo catheter in 27(32.1%) and as a rescue catheter in 57(67.9%) patients. 35(41.6%) patients achieved angiographic TICI grade ≥ 2c. De novo 3MAX use led to 68.18% successful recanalization and rescue use led to 72.22% recanalization (p = 0.67) as measured by TICI score of 2c or better. Parenchymal intracerebral hemorrhages (PH) were present in 8 patients (9.5%). The Penumbra 3MAX catheter is safe and effective when used as a first pass or a rescue device in mechanical thrombectomy. We found similar rates of successful recanalization and minimal hemorrhagic risk when comparing the 3MAX as a rescue or de novo aspiration catheter.

MINT Registry: Rationale and Study Design

Background Mechanical thrombectomy has become the standard of care for treatment of acute ischemic stroke secondary to large‐vessel occlusion up to 24 hours from last known normal time. Multiple different techniques for mechanical thrombectomy have been described, including a direct aspiration first‐pass technique and stent retriever thrombectomy. With a direct aspiration first‐pass technique, classically, a large‐bore aspiration catheter is delivered over a microcatheter and microwire to the clot. Recently, a novel macrowire has been introduced as a potential alternative to the use of microwire–microcatheter to allow the delivery of the aspiration catheter. The aim of this study is to develop a multicenter registry comparing delivery of an aspiration catheter for intracranial thrombectomy for acute ischemic stroke secondary to emergent large‐vessel occlusion over a macrowire in comparison with traditional use of microcatheter and microwire. Methods MINT (Macrowire for Intracranial Thrombectomy) is a multicenter, observational study currently enrolling patients with large‐vessel occlusion who underwent mechanical thrombectomy using a macrowire to deliver the aspiration catheter to the intracranial occlusion. All the participating sites will screen and report cases on a monthly basis. The decision to use the macrowire and various aspiration catheters is at the discretion of the interventionalist. Results We will collect patient's clinical, demographic, and radiographic data. In addition, we plan to collect procedure variables and postprocedure clinical and imaging data. Outcomes include successful delivery of the reperfusion catheter to the clot interface, time taken from groin access to first pass, and a bailout strategy for thrombectomy in cases where this is not feasible. Conclusion The MINT registry will add to our understanding of safety and efficacy of this novel macrowire in intracranial thrombectomy. This registry will also highlight and allow for understanding in workflow improvements from simplifying setup and possibly cost effectiveness of this technique.

First-Line Aspiration Thrombectomy of M2 Occlusions with a Novel Reperfusion Catheter (REDTM 62): Real-World Experience from Two Tertiary Comprehensive Stroke Centers.

The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical features and initial results of a novel reperfusion catheter (REDTM 62) used for frontline aspiration thrombectomy of M2 occlusions in acute ischemic stroke patients. Appropriate aspiration catheters are crucial for a successful ADAPT maneuver; however, the selection of catheters suitable for smaller-sized vessels is scarce compared to the ones for large vessel occlusions. All patients treated with ADAPT using REDTM 62 as the frontline treatment approach for acute M2 occlusions between December 2022 and February 2024 were retrospectively enrolled. Demographic data, procedural timings and safety, recanalization rates, and outcome data were recorded. Twenty patients with a median admission National Institutes of Health Stroke Scale (NIHSS) score of 8 were identified. Successful revascularization (DMVO-thrombolysis in cerebral infarction [TICI]≥2b) with REDTM 62 aspiration thrombectomy was obtained in 65.0% (13/20) of cases. The first pass effect was 45.0% (9/20). In 2 cases, the REDTM 62 did not reach the clot due to marked distal vessel tortuosity. Stent retrievers were additionally used in 9 cases and led to an overall DMVO-TICI 2c/3 of 90.0% (18/20). Mean procedural time was 48 minutes. No complications directly related to ADAPT occurred. In-hospital mortality rate was 20.0% (4/20). The median discharge NIHSS score was 2.5. A good functional outcome at discharge (modified Rankin scale 0-2) was achieved in 55.0% (11/20) of cases. Our initial experiences with the novel REDTM 62 reperfusion catheter for treatment of M2 occlusions is in line with published data. ADAPT using this catheter may be considered as a safe and effective first-line treatment option. Further studies are warranted to validate the initial results.