Steerable Catheter Research Articles

3D printed training simulator for transcatheter edge-to-edge repair of the tricuspid valve: A proof-of-concept

BackgroundTricuspid regurgitation (TR) treatments have gradually shifted toward a more interventional approach and transcatheter edge-to-edge repair (TEER) has assumed a first-order role. TriClip™ by Abbott (Menlo Park, USA) is one of the most widely used devices for tricuspid repair. TEER procedures are recognised as technically challenging, characterized by a steep learning curve. For this reason, specialized training is necessary. The aim of this work is to develop and test a novel 3D printed training simulator, which considers both anatomical and mechanical characteristics, specifically designed for this kind of procedure. MethodsStarting from routinely acquired computed tomography (CT) images, a 3D digital model of the heart was reconstructed. This was then properly “augmented”, so that it could realistically reproduce the key features involved in the procedure. The simulator was manufactured exploiting the Polyjet 3D printed. Proper materials selection was performed to accurately reproduce mechanical properties. The manufactured prototype was then tested by a specialized professional, with the TriClip™ system. ResultsThe simulator was assessed to practice access, navigation, catheter steering and leaflet grasping. Throughout the process, appropriately placed cameras ensured that the operators could visualize the crucial steps on a screen. Even if a deeper evaluation is needed, preliminary feedback is satisfactory. ConclusionsIn this study, a new training simulator for TriClip™ procedure was designed, produced, and preliminary assessed. Further studies will have to demonstrate the advantages of using this simulator design to shorten the learning curve and subsequently lead to better clinical outcomes.

Utilizing a Guiding Catheter to Improve Endovascular Therapy Outcomes for Acute Vertebrobasilar Artery Occlusion in Patients with Tortuous Vessels.

Objective Stable and swift placement of a guiding catheter in endovascular therapies for acute vertebrobasilar artery occlusion is often difficult because of the tortuous bends of the vertebral or subclavian artery especially in older people. The use of a delivery assist guiding catheter (DAGC) shortens the time with stable support to deliver a therapeutic treatment catheter to the target lesions. Herein, we reported the clinical and radiographic outcomes in endovascular therapies utilizing the DAGC for acute vertebrobasilar artery occlusions in actual clinical settings. Materials and Methods Between January 2018 and December 2021, 33 consecutive patients (males, 20[60.6%]; median age, 78 years) using a DAGC for acute vertebrobasilar artery occlusion were analyzed retrospectively. Reperfusion was graded using postinterventional angiograms based on the "thrombolysis in cerebral infarction" (TICI) classification. Furthermore, the time from puncture to recanalization and the rate of effective recanalization achievement were investigated. Results Effective recanalization with TICI 2b or 3 was achieved in 28 (84.8%) patients, and the median time from puncture to recanalization was only 44 minutes, despite the high rate of older patients in our cohort. In contrast, asymptomatic intracranial hemorrhage as a complication was observed in only 3 (9.1%) patients. Conclusion The DAGC contributes to the shortening of recanalization time and improves the outcomes of endovascular therapies for acute vertebrobasilar artery occlusion.

Validating peak frequency mapping for atrial far-field electrogram detection: insights from a pulmonary vein isolation model

Abstract Introduction Effective pulmonary vein isolation (PVI) is the cornerstone of AF ablation, and conduction block from the atrium to the pulmonary veins (PV) is the accepted method to demonstrate it. However, far-field electrograms may make challenging to establish whether PVI has been achieved. Purpose This study aimed to evaluate whether peak frequency (PF) mapping can effectively identify far-field electrograms in the superior PVs following a redo PVI procedure. Methods Left atrium and PV activation and voltage bipolar 3D electroanatomical maps were generated using a steerable catheter with a 16-grid-patterned electrode configuration (HD-Grid) during coronary sinus pacing, both before and after the redo PVI. PF maps were developed offline using specialized experimental software. Only reconnected superior PVs from the redo PVI procedure were included in the analysis. Results Twenty consecutive patients (mean age 63±12 years, 12 male) were prospectively enrolled in the study, with 15 presenting reconnected PVs after the redo PVI. Conduction gaps were identified in the superior PVs of 9 patients (7 in the left superior PV, 5 in the right superior PV). Following the redo PVI, both voltage (0.96±1.1 mV vs. 0.49±1.21, P<0.01) and PF (285±134 vs. 153±112 Hz, P<0.001) were significantly reduced in both superior PVs. This reduction was more prominent in the right superior PV (0.83±0.75 vs. 0.20±0.39 mV, 299±159 vs. 132±116 Hz) than in the left superior PV (1.08±1.32 vs. 0.83±1.67 mV, 272±105 vs. 178±101 Hz). High-voltage (>0.3 mV) electrograms remained prevalent in the right (12%) and left (37%) superior PVs after the redo PVI. However, high PF (>250 Hz) electrograms significantly decreased following PVI in both the right (64% before vs. 6% after PVI) and left (66% before vs. 22% after PVI) PVs. Only a small percentage (5.3% in the right PV and 12% in the left PV) of all electrograms exhibited both high voltage and high PF following the PVI (see figure). Conclusion PF mapping proves to be a valuable tool in distinguishing far-field electrograms from atrial activity in the PVs, offering additional insights to complement voltage mapping, particularly in the context of redo PVI procedures.

Understanding transcatheter edge-to-edge repair "knobology": Advanced catheter steering for different scenarios of transseptal puncture.

Following the introduction in the latest European and American guidelines, transcatheter edge-to-edge repair has become a valid alternative to surgery for ineligible patients. Among the available technologies, MitraClip (Abbott) was the first to be introduced for the percutaneous treatment of mitral regurgitation with the edge-to-edge technique. Although its safety and effectiveness has been widely demonstrated, the optimal procedural results are highly dependent from operators' experience. In this manuscript, we provide a full guide of advanced steering maneuvers of MitraClip in different scenarios of transseptal puncture.

D-37 | Guide Catheter Extension Use in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS CTO Registry

D-37 | Guide Catheter Extension Use in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS CTO Registry

Retrograde Intrarenal Surgery for Lithiasis Using Suctioning Devices: A Shift in Paradigm?

New suction endoscopes, ureteral access sheaths (UAS) and catheters aim to improve the efficacy of flexible ureteroscopy and optimize its safety. Suction UAS with non-flexible tips have shown promising results, especially in maintaining low intrarenal pressure, but also in removing small debris and reducing the "snow globe" effect. In addition, suctioning UAS with a flexible tip offers the advantage of being able to be navigated through the pyelocaliceal system to where the laser lithotripsy is performed. It can also remove small stone fragments when the flexible ureteroscope is retracted, using the Venturi effect. Direct in-scope suction (DISS) involves aspirating dust and small stone debris through the working channel of a flexible ureteroscope, thus regulating intrarenal pressure and improving visibility. Steerable aspiration catheters are other devices designed to increase stone clearance of the pyelocaliceal system. They are inserted under fluoroscopic guidance into every calyx after retraction of the flexible ureteroscope, alternating irrigation and aspiration to remove dust and small gravels. Combining flexible-tip suction UAS and the DISS technique may offer some advantages worth evaluating. The advantage of using these instruments to achieve a low intrarenal pressure was demonstrated. The true practical impact on the long-term stone-free status is a matter requiring further studies.

Comparison of Clinical and Radiological Outcomes Between Different (Balloon) Guide Catheter With and Without Inflated Balloon in Acute Ischemic Stroke Patients: A MaSQ-Registry Study

PurposeBalloon guide catheters (BGCs) are used in endovascular treatment (EVT) for ischemic stroke. Previous literature did not distinguish between BGC use with and without inflated balloon. This study aims to compare outcomes between non-BCG and BGC use with and without inflated balloon during EVT.MethodsPatients who underwent EVT for anterior circulation ischemic stroke between September 2020 and February 2023 were analyzed. Patients were divided into three groups: non-BGC, BGC with inflated balloon, or BGC without inflated balloon. The primary outcome was the ordinal modified Rankin Scale (mRS) at 90-day follow-up. Secondary outcomes included expanded Thrombolysis In Cerebral Ischemia score (eTICI) and periprocedural complications. Regression analyses with BGC with inflated balloon as comparator were performed with adjustments. Subgroup analyses were conducted based on first-line thrombectomy technique.ResultsOut of 511 patients, 428 patients were included. Compared to BCG with inflated balloon, the mRS at 90 days did not differ in the group without inflated balloon (adjusted common [ac]OR: 1.07, 95%CI 0.67–1.73) or non-BGC (acOR: 1.42, 95%CI 0.83–2.42). Compared to patients treated with a BGC with inflated balloon, those treated with BGC without inflated balloon had lower eTICI scores (acOR: 0.59, 95%CI 0.37–0.94), and patients treated with non-BGC had lower chances of periprocedural complications (aOR: 0.41, 95%CI 0.20–0.86).ConclusionsThis study shows no clinical differences in ischemic stroke patients treated with BGC with inflated balloon compared to non-BGC and BGC without inflated balloon, despite lower periprocedural complication rates in the non-BGC group and lower eTICI scores in the BGC without inflated balloon group.Level of EvidenceLevel 3, non-controlled retrospective cohort study.Graphical

Balloon Guide Catheter Versus Non–Balloon Guide Catheter: A MR CLEAN Registry Analysis

Background Balloon guide catheters (BGCs) are used to prevent distal emboli during endovascular treatment for acute ischemic stroke. Although literature reports benefit of BGC, these are not universally used, and randomized head‐to‐head comparisons are lacking. This study compared functional, safety, and technical outcomes between patients treated with non‐BGC and with BGC during endovascular treatment in a nationwide prospective multicenter registry. Methods Patients from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, 2014 to 2018), who underwent endovascular treatment with a non‐BGC or BGC, were included. Primary outcome was the modified Rankin Scale score at 90 days, and secondary outcomes included procedure time and first‐attempt successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2C). Treatment‐effect modification and subgroups were analyzed according to first‐line thrombectomy technique and different sizes of non‐BGC. Results In total 2808 patients were included, and 1671 (60%) were treated with BGC. No differences in the modified Rankin Scale score at 90 days were seen between non‐BGC and BGC groups (adjusted common odds ratio [OR], 0.98 [95% CI, 0.82–1.10]). The non‐BGC was associated with faster procedure times compared with BGC (adjusted β: −2.99 [95% CI, −5.58 to −0.40]). A significant treatment effect was found between BGC use and thrombectomy technique. In subgroup analyses with stent retriever as first‐line technique, 90‐day modified Rankin Scale scores were significantly higher (more disability) in the non‐BGC group compared with the BGC group (adjusted common OR, 0.79 [95% CI, 0.65–0.96]). Direct aspiration combined with non‐BGC resulted in higher first‐attempt rates compared with BGC (adjusted OR, 1.55 [95% CI, 1.06–2.28]). Conclusions This large prospective multicenter registry showed no differences in clinical outcome between patients treated with non‐BGC and BGC. Subgroup analyses suggest that BGC outperforms the non‐BGC when stent retriever is used as first‐line technique, whereas non‐BGC outperforms the BGC when aspiration is used.

A novel troubleshooting technique for below-the-knee artery occlusions with proximal cap ambiguity: Transpedal Retrograde Wire Just Marker Technique.

Chronic total occlusions with ambiguous proximal caps pose a challenging problem in below-the-knee artery endovascular interventions. We defined a new technique for antegrade puncture and penetration of an ambiguous proximal cap in a 52-year old male patient with a non-healing wound on his right forefoot. Anterior tibial artery (ATA) was determined as the target vessel; however, its origin and course could not be determined. A retrograde guidewire (Asahi Gladius 0.018 inch, Asahi Intecc) was advanced into the distal ATA via transpedal loop following pedal loop angioplasty. This guidewire was advanced through and parked to the tibioperoneal trunk with a small distal loop at the tip. While the looped wire was held in its position as a marker for ATA ostium, a second guidewire (Asahi Gladius 0.018 inch, Asahi Intecc) with the guidance of 4F vertebral catheter (Vert Catheter, Merit Medical) successfully penetrated the ambiguous cap and subsequent target vessel revascularization was achieved with 2.5/150mm peripheral balloon angioplasty catheter (Minerva SC 0.018 inch, BrosMed Medical). Transpedal Retrograde Wire Just Marker Technique is a novel and practical technique which can be used in chronic total occlusions of below-the-knee arteries with ambiguous proximal caps.

315 A Propensity Score-matched Comparative Study of Balloon Guide Catheters Versus Conventional Guide Catheters for Mechanical Thrombectomy With Stenting in Tandem Strokes: Comparison of 1st-pass Effect, Symptomatic ICH, and 90-day Functional Outcomes

INTRODUCTION: Extensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown benefit of balloon guide catheters (BGC) in MT and carotid artery stenting. METHODS: Tandem stroke patients identified from our endovascular database were dichotomized into groups treated with BGCs versus conventional guide catheters. One-to-one PSM adjustment for baseline demographics and treatment selection bias using nearest-neighbor matching was performed. Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes assessed were final modified thrombolysis in cerebral infarction (mTICI) grade, periprocedural symptomatic intracranial hemorrhage (sICH) rate, in-hospital mortality, and 90-day modified Rankin Scale (mRS) score. Mann-Whitney U-test and multivariate logistic regression were performed to compare procedural parameters and clinical outcomes. RESULTS: Concurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC: 85; no BGC: 40). After PSM (40 patients/group), BGC group had a significantly shorter procedure duration (77.9 vs. 61.5 min; odds ratio [OR] = 0.996; p = 0.006), lower discharge National Institutes of Health Stroke Scale score (8.0 vs. 11.0; OR = 0.987; p = 0.042), and higher odds of 90-day mRS 0-2 score (52.3% vs. 27.5%; OR = 0.34; p = 0.040). On multivariate regression, BGC group had a significantly higher first-pass effect rate (mTICI: 2B-3) (OR = 1.115, 95% confidence interval [CI] = 1.015-1.432; p = 0.013) and lower periprocedural sICH rate (OR = 0.615; 95% CI = 0.406-0.932; p = 0.025). No difference in in-hospital mortality was observed (OR = 1.591; 95% CI = 0.976-2.593; p = 0.067). CONCLUSIONS: BGCs used for concurrent MT–carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in tandem stroke patients.

Combined Aspiration and Stent Retriever Thrombectomy for Distal Carotid Artery Occlusion Using Balloon Guide versus Non-Balloon Guide Catheter.

Background: The introduction of endovascular thrombectomy dramatically changed acute stroke management and became the standard treatment. Balloon guide catheters provide flow arrest during the clot retrieval process and have several advantages.This study aimed to compare balloon guide catheters (BGCs) versus non-balloon guide catheters (NBGCs) as a part of a combined treatment modality in patients presenting with acute ischemic stroke. Methods: This retrospective study included n = 65 patients who underwent a combined endovascular stroke treatment for distal internal carotid artery (ICA) occlusion. Patients underwent aspiration and stent retriever thrombectomy with the use of BGCs (Group 1, n = 27) or NBGCs (Group 2, n = 38). Results: The groups were compared for outcomes: the National Institutes of Health Stroke Scale (NIHSSS) score change, successful recanalization, good functional outcome at three months, and in-hospital mortality. Conclusion: The two groups didn't differ in terms of the NIHSS score change compared to baseline (p > 0.05). Moreover, there were no significant differences between the two groups in terms of the successful recanalization rate, three-month favorable functional outcome rate, and in-hospital mortality (p = 0.292, p = 0.952, p = 0.178), respectively. Further prospective studies with a larger number of patients and better methodology are warranted.

Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions.

Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in theGCE group were older and had more comorbidities. The medianJ-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.

Path tracking control of a steerable catheter in transcatheter cardiology interventions

PurposeIntracardiac transcatheter interventions allow for reducing trauma and hospitalization stays as compared to standard surgery. In the treatment of mitral regurgitation, the most widely adopted transcatheter approach consists in deploying a clip on the mitral valve leaflets by means of a catheter that is run through veins from a peripheral access to the left atrium. However, precise manipulation of the catheter from outside the body while copying with the path constraints imposed by the vessels remains challenging.MethodsWe proposed a path tracking control framework that provides adequate motion commands to the robotic steerable catheter for autonomous navigation through vascular lumens. The proposed work implements a catheter kinematic model featuring nonholonomic constraints. Relying on the real-time measurements from an electromagnetic sensor and a fiber Bragg grating sensor, a two-level feedback controller was designed to control the catheter.ResultsThe proposed method was tested in a patient-specific vessel phantom. A median position error between the center line of the vessel and the catheter tip trajectory was found to be below 2 mm, with a maximum error below 3 mm. Statistical testing confirmed that the performance of the proposed method exhibited no significant difference in both free space and the contact region.ConclusionThe preliminary in vitro studies presented in this paper showed promising accuracy in navigating the catheter within the vessel. The proposed approach enables autonomous control of a steerable catheter for transcatheter cardiology interventions without the request of calibrating the intuitive parameters or acquiring a training dataset.

The Effect of Mixing Iodinated Contrast Media and Ultrasound Contrast Agents on Subharmonic Signals.

Subharmonic aided pressure estimation (SHAPE) is a technique that utilizes subharmonic signals from microbubble contrast agents for pressure estimation. Validation of the SHAPE technique relies on synchronous measurements of in vivo pressures using contrast microbubbles and a pressure catheter (reference standard). For the guidance and placement of pressure catheter in vivo, iodinated contrast is used with fluoroscopy. Therefore, during data acquisition for validation studies of the SHAPE technique, both contrast microbubbles and iodinated contrast are present simultaneously within the vasculature. This study aims to elucidate the effects of iodinated contrast (Visipaque, GE HealthCare) on subharmonic signal amplitude from contrast microbubbles (Definity, Lantheus Medical Imaging, Inc.). In an acrylic water tank, 0.06 mL of Definity and varied amounts of Visipaque (0.14, 0.43, 0.85, and 1.70 mL) were added to 425 mL of deionized water. Ultrasound scanning was performed with a SonixTablet scanner (BK Medical Systems) using optimized parameters for SHAPE with Definity (ftransmit/receive = 3.0/1.5 MHz; chirp down pulse). Subharmonic data was acquired and analyzed at 9 different incident acoustic outputs (n = 3). Results showed an increase in subharmonic signal amplitude from Definity microbubbles in the presence of 0.14 mL Visipaque by 2.8 ± 1.3 dB (p < .001), no change with 0.85 mL Visipaque (0.7 ± 1.2 dB; p = .09) and a decrease in subharmonic amplitude in the presence of 1.70 mL Visipaque by 1.9 ± 0.7 dB (p < .001). While statistically significant effect on subharmonic signal amplitude of Definity microbubbles was noted due to the mixture, the magnitude of the effect was minimal (~2.8 dB) and unlikely to impact in vivo SHAPE measurements.

(182) Transurethral Laser Incision of Ejaculatory Duct for Complete Ejaculatory Duct Obstruction

Abstract Introduction It is estimated that approximately 5% of men presenting with infertility suffer from ejaculatory duct obstruction (EDO). Patients suspected to have EDO typically have a palpable vas deferens and normal testicular exam. On semen analysis, low volume and acidic pH should increase suspicion, and transrectal ultrasound is most commonly the first diagnostic modality utilized to confirm the diagnosis when suspecting EDO. Objective The objective of this surgical video is to describe the use of holmium laser for the management of ejaculatory duct obstruction (EDO) in the setting of obstructive azoospermia. Methods This was a 35 year old male with no significant past medical history who presented with obstructive azoospermia. His partner was a 32 year old female with no significant past medical history, with regular menstrual cycles, and a normal female reproductive evaluation. Semen analysis was significant for low volume (0.5 mL) azoospermia with an acidic pH (6.8). Abdominal and pelvic computerized tomography (CT) scan from 2017 when the patient presented for appendicitis noted an incidental finding of a 9.9 cm prostatic cyst. Thus, a transrectal ultrasound (TRUS) guided aspiration was performed in the ambulatory clinic which demonstrated a large prostatic cyst, with non-motile sperm in the aspirate. The patient was consented for Cystoscopy with transurethral laser incision of ejaculatory ducts. A 22 French (F) cystoscope was used, first for pan-cystourethroscopy, and then to cannulate the right ejaculatory duct with 5F pollack catheter and guide wire. Guide wire and catheter positioning within the cyst was confirmed with fluoroscopy. A 24F resectoscope with a laser bridge working element and 550 micron holmium laser fiber at settings of 1 Joule of energy and 10 hertz frequency to incise the right ejaculatory duct, circumferentially around the wire. The ejaculatory duct was incised and cyst was drained until the ejaculatory duct and thus prostatic cyst could be cannulated and examined with the cystoscope. On examination of the cyst, no vasal openings were identified. Left seminal vesiculography was attempted but unsuccessful due to significant contrast extravasation into the urethra. Results The case went well and was uncomplicated. There were no immediate or delayed complications or adverse effects reported by the patient. Post-operative instructions included rest for 1 week, followed by ejaculation every other day for 3 months. Semen analysis and transrectal ultrasound will be performed at 3 months post-operative. Conclusions Transurethral laser incision of ejaculatory duct is a safe surgical intervention for management of complete ejaculatory duct obstruction, and is demonstrated successfully in this step-by-step surgical video. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

Abstract TP187: Comparison of Balloon Guide Catheter versus Non-Balloon Guide Catheter for Mechanical Thrombectomy in Distal Medium Vessel Occlusion

Introduction: While balloon guide catheters (BGCs) enhance safety and efficacy of mechanical thrombectomy in large vessel occlusions, their impact on distal medium vessel occlusion (DMVO) remains underexplored. This study aimed to compare the outcomes of BGC vs non-BGC in DMVO thrombectomy. Methods: This retrospective study focused on DMVO cases defined as occlusions in M2-M4 middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. Baseline characteristics and technical and clinical outcomes were compared between the two groups, with subgroup analysis in first-line thrombectomy techniques, including ADAPT, stent retriever, and Solumbra. First pass effect (FPE) was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥ 2C after the first pass. Results: A total of 1,508 patients were included, of whom 231 (15.3%) were in the BGC group and 1,277 (84.7%) were in the Non-BGC group. The BGC group was associated with a lower mTICI score ≥ 2C (overall: 43.2% vs. 52.7%, p = 0.01; ADAPT: 42.2% vs. 57.1%, p = 0.01; Solumbra: 32.4% vs. 51.4%, p = 0.005), longer puncture to intracranial access time (overall: 15 vs. 8 min, p &lt; 0.001; ADAPT: 17 vs. 8 min, p &lt; 0.001; Solumbra: 12 vs. 8 min, p = 0.02), and longer puncture to recanalization time (overall: 97 vs. 35 min, p &lt; 0.001; ADAPT: 100 vs. 28 min, p &lt; 0.001; Solumbra: 78 vs. 46 min, p &lt; 0.001; Stent retriever: 95 vs. 45 min, p &lt; 0.001 ). The BGC group also had a lower FPE rate (17.4% vs. 30.7%, p = 0.03) in the Solumbra subgroup. In terms of clinical outcomes, the BGC group had a lower rate of distal embolization (overall: 8.8% vs. 14.9%, p = 0.02), but there were no significant differences in other clinical outcomes between the two groups in first-line thrombectomy techniques. Conclusions: Our findings showed that the use of BGC in DMVO had a lower mTICI score, reduced FPE rates, decreased distal embolization, and longer procedure times. Figure 1: Figure 2:

Abstract WP198: Balloon Guide Catheter Impact on Angiographic and Clinical Outcomes in Distal Medium Vessel Occlusion Strokes Undergoing Thrombectomy

Background: The use of balloon guide catheter (BGC) has been associated with better reperfusion and clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS). The association between BGC and angiographic and clinical outcomes in patients with distal medium vessel occlusion strokes (DMVO) undergoing MT has not been investigated. Methods: This is a retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe. Patients were included if they had anterior circulation DMVO due to MCA-M3/M4 or ACA-A1/A2-3 and were treated with MT using stentriever, contact aspiration, or a combination of both techniques as first-line therapy. The cohort was divided into two groups: 1) BGC and 2) non-BGC. Uni and multivariable analyses were used to identify predictors of first pass effect (FPE) defined as eTICI grade 2C or 3 after single device pass, as well as mRS0-1, mRS0-2, and mortality at 90 days. Results: A total of 199 patients were eligible for analysis. The BGC group (n=73) had comparable baseline characteristics as compared to the non-BGC group (n=126), except for lower median age and frequency of hyperlipidemia, atrial fibrillation, and White patients, and higher frequency of tandems. Procedurally, the BGC group had a less frequent use of contact aspiration (23.3% vs. 53.2%), and higher proportions of stent-retriever use (35.6% vs. 13.5%) and combined technique (41.1% vs. 33.3%; P&lt;0.001) as first-line therapy. A lower number of passes (1 vs. 2, P&lt;0.001), shorter procedure time (40 vs. 46 minutes, P=0.029), and higher FPE rates (53% vs 13%; P&lt;0.001) were observed in the BGC group. On multivariable analysis, the BGC group showed higher rates of FPE (53.4% vs. 13.7%, aOR 6.74, 95%CI [3.08-14.75], P&lt;0.001), 90-day mRS 0-1 (42.9% vs. 27.1%, aOR 2.28, 95%CI [1.06-4.91], P=0.035), and 90-day mRS 0-2 (60.3% vs. 41.5%, aOR 2.47, 95%CI [1.15-5.31], P=0.02). The rates of successful reperfusion at the end of the procedure, sICH, and 90-day mortality were comparable between both groups. Conclusions: The present study suggests that the use of BGC in DMVO undergoing MT is associated with improved angiographic and clinical outcomes with no safety concerns. Prospective studies are warranted.

Modes of failure of guide catheter extensions: Insights from the MAUDE database.

Guide catheter extensions (GCEs) are commonly used to facilitate percutaneous coronary interventions (PCIs). We investigated the incidence and modes of failure of GCEs.. Data from the Manufacturer and User Facility Device Experience (MAUDE) database between 2012 and 2022 were used to investigate the most common modes of failure and related adverse events with the use of GCEs. We performed analysis of 4 commonly used catheters: GuideLiner (Teleflex), Guidezilla (Boston Scientific), TrapLiner (Teleflex), and Telescope (Medtronic). The first event reported for GuideLiner was in 2012, Guidezilla in 2018, TrapLiner in 2017, and Telescope in 2019. During the study period, a total of 651 events were reported to the database. A total of 429 true GCE device failures were identified: 59 (14%) for GuideLiner, 297 (69%) for Guidezilla, 47 (11%) TrapLiner, and 26 (6%) for Telescope. Catheter detachment or fracture was the most frequently reported device failure for all 4 GCEs; these failures included shaft fractures, tip deformations, and collar detachments. We identified 222 reported events as unspecified adverse events; these events included device-to-device incompatibility, difficulty to advance, and device fractures outside the patient body. Only 58 (8.9%) events resulted in patient complication. Of these, coronary artery dissection was the most frequently reported complication. Device detachment/fracture is the most common mode of device failure in all 4 GCEs, and coronary dissection is the most common patient complication.

Effectiveness of S-Shaping of the Tip of the FUBUKI Guiding Catheter to Match the Shape of the Cervical Internal Carotid Artery in Anterior Circulation Cerebral Aneurysm Embolization.

During cerebral aneurysm embolization of the anterior circulation, the guiding catheter (GC) should be placed as distally as possible in the cervical internal carotid artery (ICA) to secure the maneuverability of the microcatheter and distal access catheter. However, if the shape of the tip of the GC does not appropriately match the course of the ICA, blood stasis might occur. We investigated whether shaping the tip of the GC into an S-shape would allow more stable catheterization to the distal ICA than the conventional GC with an angled tip. We included patients with cerebral aneurysms of the anterior circulation who were treated at our institution from April 2019 to April 2021. First, we evaluated the cervical ICA course in these patients through cerebral angiography and classified the courses into type S, type I, and type Z. Then, we focused on the most frequently encountered type-S cervical ICA to investigate the forging effect of the GC tip into an S-shape. We evaluated the lateral view of the carotid angiograms to examine whether the catheter tip reached the foramen magnum (FM) without interrupting ICA blood flow. The effects of age, sex, side, a history of hypertension and smoking, and an S-shape modification of the GC tip on the outcome of GC placement were analyzed. A total of 67 patients were included in this study. The tip of the GC was placed at the FM in 27 cases. Among these factors, only the S-shape modification was significantly associated with whether the GC could be placed at the level of the FM (p <0.0001). By forging the tip of the GC into an S-shape, the GC can be safely advanced to the distal part of the cervical ICA, which may contribute to the improved maneuverability of microcatheters.

Feasibility and Challenges of Transradial Approach in Neuroendovascular Therapy: A Retrospective Observational Study.

Transradial approach (TRA) is increasingly used as a viable alternative to the traditional transfemoral approach (TFA) in neuroendovascular therapy (NET) owing to its potential anatomical benefits and lower puncture-site complication rates. However, the real-world challenges of implementing TRA-NET have not been thoroughly studied, particularly those related to guide catheter (GC) placement. In this study, we aimed to explore the feasibility and challenges of TRA-NET, with a specific focus on GC placement. This retrospective observational study included patients who underwent NET at our institution between December 2019 and May 2022. Procedural success was defined as the successful placement of a GC in the target vessel. Cases in which a Simmons-shaped GC was used or the approach was changed to TFA were classified as difficult. Safety was assessed based on the rate of severe puncture-site complications requiring either blood transfusion or surgical intervention. Among the 310 patients who underwent NET during the study period, 222 (71.6%) with a median age of 74 years were selected for TRA-NET. The target vessel was in the left anterior circulation (LtAC) in 101 (45.5%) patients, and 8-F GCs were the most frequently used (40.1%). TRA-NET achieved a 95.0% success rate, with a switch to TFA required in 5.0% of the cases. Procedural challenges occurred in 42 (18.9%) patients, primarily in those with LtAC lesions. Specifically, a type III aortic arch (p <0.0001) and age ≥80 years (p = 0.01) were significantly associated with procedural difficulties. Radial artery evaluation was confirmed in 66 cases (29.7%), revealing one instance (1.5%) of radial artery occlusion. No severe puncture-site complications were observed. TRA-NET may provide substantial therapeutic benefits without significant limitations in device use. However, it may be challenging, particularly in older patients and those with a type III aortic arch with LtAC lesions. Consequently, careful selection of the approach route is imperative.