Direct Aspiration Thrombectomy Research Articles

Application of optical magnetic resonance imaging detection in the safety of direct aspiration thrombectomy for acute intracranial arterial occlusion surgery

Application of optical magnetic resonance imaging detection in the safety of direct aspiration thrombectomy for acute intracranial arterial occlusion surgery

Vac-lock augmented direct aspiration thrombectomy – A novel method of an aspiration first-pass approach for acute ischaemic stroke

Vac-lock augmented direct aspiration thrombectomy – A novel method of an aspiration first-pass approach for acute ischaemic stroke

VacLok-Augmented Direct Aspiration Thrombectomy

VacLok-Augmented Direct Aspiration Thrombectomy

Aspiration Versus Stent Retriever Thrombectomy in Basilar‐Artery Occlusion; Results From the BASICS Trial

Background Both aspiration and stent retriever thrombectomy are safe and effective in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation. Little is known on the outcomes of these techniques in patients with basilar artery occlusion. This study aimed to compare clinical, technical, and safety outcomes of aspiration and stent retriever thrombectomy as first‐line treatment for basilar artery occlusion in the BASICS (Basilar artery International Cooperation Study) trial. Methods For this post hoc analysis of the BASICS trial, all patients with a basilar artery occlusion who received endovascular treatment with either direct aspiration or stent retriever thrombectomy as first‐line approach were included. When both techniques were registered as first choice, patients were considered to have been treated with stent retriever. The primary outcome was favorable functional outcome, defined as a modified Rankin scale score of 0–3 at 90 days follow‐up, and analyzed using binary logistic regression analysis. Secondary outcomes included the modified Rankin scale score at 90 days (ranging from 0 to 6), procedure duration, mortality at 90 days, and symptomatic intracranial hemorrhage. Secondary outcomes were analyzed using binary, linear, or ordinal regression analyses. All analyses were adjusted for predefined variables. Results Among 158 BASICS patients treated with endovascular treatment,127 were treated with either stent retriever (N=67, 53%), or aspiration (N=60, 47%) as the first‐line treatment modality. We observed no significant difference in favorable functional outcome between patients treated with aspiration and stent retriever thrombectomy as first modality (adjusted odds ratio, 1.80; [95% CI, 0.68–4.76]). Also modified Rankin scale score at 90 days (adjusted common odds ratio, 0.62; [95% CI, 0.30–1.27]) and incidence of symptomatic intracranial hemorrhage (adjusted odds ratio, 0.61; [95% CI, 0.08–4.76]) showed no significant differences between both techniques. Procedure time was shorter with a median of 32 versus 47 minutes (26%; 95% CI, −42 to −6) and mortality rates at 90 days were lower (adjusted odds ratio, 0.36; [95% CI: 0.13–1.00]) in the direct aspiration group. Conclusions This study shows no difference in favorable functional outcome in patients with a basilar artery occlusion treated with direct aspiration compared with patients treated with stent retriever thrombectomy within the BASICS trial, despite a shorter procedure time and lower mortality rate at 90 days.

Initial Experience Using the New pHLO 0.072-inch Large-Bore Catheter for Direct Aspiration Thrombectomy in Acute Ischemic Stroke.

A direct aspiration, first pass technique (ADAPT) has been introduced as a rapid and safe thrombectomy strategy in patients with intracranial large vessel occlusion (LVO). The aim of the study is to determine the technical feasibility, safety, and functional outcome of ADAPT using the newly released large bore pHLO 0.072-inch aspiration catheter (AC; Phenox). We performed a retrospective analysis of data collected prospectively (October 2019-November 2021) from 2 comprehensive stroke centers. Accessibility of the thrombus, vascular recanalization, time to recanalization, and procedure-related complications were evaluated. National Institutes of Health stroke scale scores at presentation and discharge and the modified Rankin scale (mRS) score at 90 days post-procedure were recorded. Twenty-five patients (14 female, 11 male) with occlusions of the anterior circulation were treated. In 84% of cases, ADAPT led to successful recanalization with a median procedure time of 28 minutes. In the remaining cases, successful recanalization required (to a total of 96%; modified thrombolysis in cerebral infarction score 2b/3) the use of stent retrievers. No AC-related complications were reported. Other complications included distal migration of the thrombus, requiring a stent-retriever, and symptomatic PH2 hemorrhage in 16% and 4%, respectively. After 3 months, 52% of the patients had mRS scores of 0-2 with an overall mortality rate of 20%. Results from our retrospective case series revealed that thrombectomy of LVOs with pHLO AC is safe and effective in cases of large-vessel ischemic stroke. Rates of complete or near-complete recanalization after the first pass with this method might be used as a new benchmark in future trials.

A comparative study of stent thrombectomy and direct aspiration thrombectomy in the treatment of ischemic stroke caused by acute middle cerebral artery M2 segment occlusion

A comparative study of stent thrombectomy and direct aspiration thrombectomy in the treatment of ischemic stroke caused by acute middle cerebral artery M2 segment occlusion

Arterial Collapse during Thrombectomy for Stroke: Clinical Evidence and Experimental Findings in Human Brains and In Vivo Models.

Aspiration thrombectomy has become a preferred approach to recanalize large-vessel occlusion in stroke with a growing trend toward using larger-bore catheters and stronger vacuum pumps. However, the mechanical response of the delicate cerebral arteries to aspiration force has not been evaluated. Here, we provide preclinical and clinical evidence of intracranial arterial collapse in aspiration thrombectomy. We presented a clinical case of arterial collapse with previously implanted flow diverters. We then evaluated the effect of vacuum with conventional aspiration catheters (with and without stent retrievers) in a rabbit model (n = 3) using fluoroscopy and intravascular optical coherence tomography. Then, in a validated human cadaveric brain model, we conducted 168 tests of direct aspiration thrombectomy following an experimental design modifying the catheter inner diameter (0.064 inch, 0.068 inch, and 0.070 inch), cerebral perfusion pressures (mean around 60 and 90 mm Hg), and anterior-versus-posterior circulation. Arterial wall response was recorded and graded via direct transluminal observation. Arterial collapse was observed in both the patient and preclinical experimental models. In the human brain model, arterial collapse was observed in 98% of cases in the M2 and in all the cases with complete proximal flow arrest. A larger bore size of the aspiration catheter, a lower cerebral perfusion pressure, and the posterior circulation in comparison with the anterior circulation were associated with a higher probability of arterial collapse. Arterial collapse does occur during aspiration thrombectomy and is more likely to happen with larger catheters, lower perfusion pressure, and smaller arteries.

Stent retriever versus direct aspiration thrombectomy for acute large vessel occlusion: A meta-analysis including 17,556 patients, from MR CLEAN to present

ObjectiveStent retriever (SR) and direct aspiration (DA) mechanical thrombectomy (MT) improve clinical outcomes for stroke secondary to large vessel occlusion. The purpose is to perform an updated meta-analysis comparing the two techniques. MethodsPubMed database was searched for studies between January 1, 2015, and July 5th, 2021 with mechanical thrombectomy to treat acute ischemic stroke. ResultsWe identified 136 studies including 17,556 patients, with 11,258 (64.1%) patients treated by SR or a combined approach and 6298 (35.9%) patients with DA. The DA group had less posterior cerebral artery strokes, was significantly older, and had lower National Institutes of Health Stroke Scale scores (p = .05,.02,.04) There was no difference between groups in percentage of middle cerebral artery or internal carotid artery occlusions or intravenous tissue plasminogen activator administered (p = .62,.19,.06). A regression model showed no difference between SR and DA in mortality, symptomatic intracranial hemorrhage, and disability (mRS > 2) at 90 days (p = .13,.75,.84). Successful reperfusion (mTICI 2b/3 rates) were higher in the DA group (DA 87.6% vs SR 82.3%, p < .01), but after accounting for covariates was not significant (p = .17). ConclusionOur updated meta-analysis shows that DA has similar safety, reperfusion and 90-day clinical outcomes compared to SR. These results should serve to increase confidence in DA thrombectomy for acute ischemic stroke secondary to LVO.

Efficacy of a Direct Aspiration First-Pass Technique (ADAPT) for Endovascular Treatment in Different Etiologies of Large Vessel Occlusion: Embolism vs. Intracranial Atherosclerotic Stenosis

Background and Aims: Aspiration thrombectomy is an effective method of recanalizing large vessel occlusion (LVO). However, the efficacy of a direct aspiration first-pass technique (ADAPT) for recanalization of LVO of different etiologies is not properly understood.Methods: The prospectively collected database on ADAPT was reviewed retrospectively. We defined two groups of enrolled patients: the embolism-related occlusions (EMB-O) group and the intracranial atherosclerotic stenosis (ICAS)-related occlusion (ICAS-O) group. Baseline characteristics, procedural variables, and post-procedural variables were collected. Multivariate logistic regression analysis was used to identify first-pass recanalization predictors.Results: Of 114 registered patients, 94 were eligible for this study (51 patients in the EMB-O group and 43 patients in the ICAS-O group). Achieving successful reperfusion immediately after direct aspiration was more frequent in the EMB-O group than in the ICAS-O group (64.71 vs. 27.91%, respectively, p = 0.006), with fewer additional rescue treatments needed (35.29 vs. 70.09%, respectively, p = 0.001). The EMB-O group also showed a higher final successful reperfusion rate (96.8 vs. 74.41%, p = 0.006). However, the 90-day good functional outcomes were not affected by the groups. Independent predictors of first-pass success of aspiration included the isolated middle cerebral artery site of occlusion, embolic etiology, and use of larger bore catheters.Conclusions: The efficacy of ADAPT recanalization approach was better in EMB-O than in ICAS-O. In case of embolic etiology and the isolated MCA site of occlusion, using a larger aspiration catheter for direct aspiration thrombectomy may be reasonable.

Direct aspiration thrombectomy as a first-pass approach for very elderly patients with ischemic stroke

ObjectiveThis study aimed to determine whether an age of ≥ 80 years would affect the radiological and clinical outcomes of the direct aspiration first pass strategy for large vessel occlusion. MethodsThis study analyzed single-center data of patients with stroke who were treated with mechanical thrombectomy between May 2018 and October 2020. Baseline characteristics, as well as radiological and clinical outcomes of patients were recorded, analyzed, and compared between the very elderly (≥80 years) and elderly patients (<80 years). ResultsSixty patients underwent mechanical thrombectomy using the Sofia aspiration catheter for mainstem occlusion of the middle cerebral artery. The direct aspiration first pass strategy was effective in 56.3% (n = 9) and 54.4% (n = 24) in the very elderly and elderly groups, respectively (p = 0.907). The final successful recanalization rates (thrombolysis in cerebral infarction ≥2b) were 75.0% (n = 12) and 70.5% (n = 31) in the very elderly group and elderly groups, respectively (p = 0.999). There was no significant between-group difference in the good 90-day clinical outcome (modified Rankin Scale ≤2) (50.0% and 56.8% in the very elderly and elderly groups, respectively, p = 0.639). Further, there were no significant between-group differences in complication rates. ConclusionThere was no difference in the recanalization rates and clinical outcomes of the direct aspiration first-pass strategy for patients aged ≥ 80 and < 80 years with occlusive lesions in large vessels.

Aspiration Thrombectomy: 2-Dimensional Operative Video.

Acute ischemic stroke is one of the leading causes of disability and mortality worldwide. There have been significant improvements to the treatment of acute ischemic stroke over the past 5 yr, specifically related to strokes caused by large vessel occlusions. Stent retrievers with and without local aspiration and direct aspiration alone have all been demonstrated as viable treatment options for this patient population. This case represents the surgical technique for direct aspiration for the treatment of large vessel occlusion. A 76-yr-old man presented with right-sided weakness and aphasia. His last known normal was 5 h ago. His NIHSS (National Institutes of Health Stroke Scale) was 18. The noncontrast computed tomography (CT) did not show a significant infarct burden and ASPECTS (AlbertaStrokeProgram Early CTScore) of 9. CT angiogram demonstrated a left M1 occlusion. The patient was not a candidate fortissue plasminogen activator (tPA) because of time to presentation; however, the patient was deemed to be a candidate for emergent thrombectomy. Consent was obtained per institutional guidelines for the emergent procedure and the video recording. The video demonstrates a direct aspiration thrombectomy technique for the treatment of stroke. The patient successfully underwent direct aspiration thrombectomy with a TICI 3 (thrombolysis in cerebral infarction) recanalization.

Direct aspiration thrombectomy experience with the SOFIA 6F catheter in acute ischemic stroke.

As the SOFIA (Soft torqueable catheter Optimized For Intracranial Access) 6F catheter has a large luminal diameter, it can be used as an aspiration catheter. Furthermore, it may function as an intermediate catheter when a stent retriever is required. We aimed to evaluate the usefulness of the SOFIA 6F catheter in mechanical thrombectomy with the direct aspiration first pass technique. Patients who had undergone mechanical thrombectomy (September 2017-January 2019) using the SOFIA 6F catheter in two centers were retrospectively analyzed. We used the thrombolysis in cerebral infarction (TICI) scale to evaluate the success of recanalization. National Institutes of Health Stroke Scale scores on admission and discharge were used together with the modified Rankin Scale (mRS) scores at 90days. In 132 (89.1%) of the 148 cases, the thrombus was in the anterior system. The SOFIA 6F catheter reached the thrombus site in 130 (87.8%) cases. The rate of successful recanalization (TICI ≥ 2b) was 89.1%. The targeted clinical outcome (mRS score ≤ 2 at 90th days) was achieved in 49.3% of cases. Symptomatic intracranial hemorrhage occurred in 5.4%. The rate of emboli to new vascular territories was 5.4%. Mortality was 14.1%. In the majority of our cases, the SOFIA 6F catheter provided effective and rapid recanalization with aspiration thrombectomy.

急性缺血性脑卒中治疗中直接抽吸除栓术的血流动力学计算机仿真研究进展

急性缺血性脑卒中治疗中直接抽吸除栓术的血流动力学计算机仿真研究进展

Comparison of aspiration-first versus stentriever-first techniques in performing mechanical thrombectomy for large vessel occlusions

BackgroundBoth stentriever and direct-aspiration thrombectomy effectively treat large-vessel occlusions. However, data are limited comparing clinical outcomes after aspiration-first versus stentriever-assisted aspiration for thrombectomy.MethodsA retrospective cohort study compared procedure times and...

Reflections on Direct Aspiration Thrombectomy for Acute Stroke: Commentary on “Lessons Learned Over More Than 500 Stroke Thrombectomies Using ADAPT with Increasing Aspiration Catheter Size”

Reflections on Direct Aspiration Thrombectomy for Acute Stroke: Commentary on “Lessons Learned Over More Than 500 Stroke Thrombectomies Using ADAPT with Increasing Aspiration Catheter Size”

Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion.

Large prospective observational studies have cast doubt on the common assumption that endovascular thrombectomy (EVT) is superior to intravenous thrombolysis for patients with acute basilar artery occlusion (BAO). The purpose of this study was to retrospectively review our experience for patients with BAO undergoing EVT with modern endovascular devices. All consecutive patients undergoing EVT with either a second-generation stent retriever or direct aspiration thrombectomy for BAO at our regional stroke center from January 1, 2013 to March 1, 2019 were included. The primary outcome measure was functional outcome at 1 month using the modified Rankin Scale (mRS) score. Multivariable logistic regression was used to assess the association between patient characteristics and dichotomized mRS. A total of 43 consecutive patients underwent EVT for BAO. The average age was 67 years with 61% male patients. Overall, 37% (16/43) of patients achieved good functional outcome. Successful reperfusion was achieved in 72% (31/43) of cases. The median (interquartile range) stroke onset to treatment time was 420 (270-639) minutes (7 hours) for all patients. The procedure-related complication rate was 9% (4/43). On multivariate analysis, posterior circulation Alberta stroke program early computed tomography score and Basilar Artery on Computed Tomography Angiography score were associated with improved functional outcome. EVT appears to be safe and feasible in patients with BAO. Our finding that time to treatment and successful reperfusion were not associated with improved outcome is likely due to including patients with established infarcts. Given the variability of collaterals in the posterior circulation, the paradigm of utilizing a tissue window may assist in patient selection for EVT. Magnetic resonance imaging may be a reasonable option to determine the extent of ischemia in certain situations.

Endovascular Contact Aspiration versus Stent Retriever for Revascularization in Patients with Acute Ischemic Stroke and Large Vessel Occlusion: A Cost-Minimization Analysis

Two main techniques for endovascular treatment of patients with acute ischemic stroke are direct aspiration and stent retriever thrombectomy. We hypothesized that the direct aspiration approach would be less costly than the stent retriever approach. We constructed a decision tree based on the 2approaches for endovascular treatment. Branch point probabilities were obtained from the best available, recently published literature. Costs were based on the list prices of medical devices from vendors. From this, we obtained a base-case analysis and conducted sensitivity analysis. Our base-case analysis revealed that the incremental cost per patient for endovascular treatment was $5937 for direct aspiration-first pass technique and $9914 for stent retriever first pass technique. The cost difference per patient treated was $3977. To drive the stent retriever first pass therapy to be the less costly option, the cost of stent retriever first pass technique has to go down more than 50%. Stent retriever first pass carries lower cost when the success rate of first-line aspiration is lower than 14.6%, which is highly improbable. Two-way sensitivity analysis revealed scenarios in which stent retriever first pass approach would be less costly than the direct aspiration-first pass approach; however, conditions required for these scenarios are rarely encountered in clinical practice. Costs of endovascular treatment using a direct aspiration-first pass approach are less than with a stent retriever first pass approach.

Thrombectomy-Related Emboli: Direct Aspiration versus Stent Retriever Thrombectomy for Acute Ischemic Stroke: Our Experience and Literature Review

Thrombectomy-related emboli (TRE) represent a potentially dangerous complication of thrombectomy procedures for acute ischemic stroke. The aim of this study was to compare the rate of TRE in aspiration thrombectomy (ASP) and stent retriever thrombectomy techniques. We retrospectively compared clinical and radiologic outcomes of 2 groups of consecutive patients with stroke, ASP group and SRT group, with TRE rates as the primary study endpoint. Emboli were classified as either affected territory emboli or unaffected territory emboli (uTRE). Relevant literature was also reviewed. The ASP group had better rates of successful recanalization (97.1% vs. 77.1%, P= 0.02), mean number of passes per case (2.0 vs. 3.3, P= 0.04), and mean operative time (34.1 minutes vs. 84.8 minutes, P < 0.0001). Thrombectomy technique (ASP vs. SRT) did not appear to predict rates of either affected territory emboli (odds ratio [OR]= 1.24, 95% confidence interval [CI] 0.33-4.63, P= 0.74) or uTRE (OR= 5.67, 95% CI 0.60-53.42, P= 0.13). Longer operative time was linked to higher uTRE rates (OR= 1.03, 95% CI 1.01-1.05, P= 0.02). ASP technique (OR 0.1, 95% CI 0.01-0.88; P= 0.04) and shorter operative time (OR= 0.98, 95% CI 0.97-0.99, P= 0.03) were linked to better rates of successful recanalization. The applied thrombectomy technique (ASP vs. SRT) is not an independent predictor of TRE rates. Operative time tends to affect the rates of uTRE and successful recanalization. The ASP technique offers higher rates of successful recanalization in less operative time.

Direct aspiration for thrombectomy in ischemic stroke: Impact of dwell time.

To evaluate the impact of dwell time on the efficacy of the direct aspiration thrombectomy in ischemic stroke. The study is a review of our prospective cerebral thrombectomy database of subjects admitted from January to December 2017. We performed direct aspiration with 2 min dwell time as recommended by the manufacturer (group 1) and 5 min dwell time (group 2) between January-June and July-December, respectively. The primary outcome was successful reperfusion after the first pass defined as modified Thrombolysis in Cerebral Infarction scores 2 b/3. Eighty-five patients had a cerebral thrombectomy by direct aspiration, 45 in group 1 and 40 in group 2. There was no statistically significant difference between the two groups but a trend toward a better modified Thrombolysis in Cerebral Infarction first pass 2 b/3 rate in group 2 (70% versus 48.8%, p = 0.06). Although not statistically significant (p = 0.07), the ratio of rescue therapy with stent retriever was higher in group 1 (40%) than in group 2 (22.5%). After all passes, modified Thrombolysis in Cerebral Infarction 2 b-3 was obtained in 82.2% (37/45) of cases in group 1 and in 90% (36/40) of cases in group 2. Among 76 patients (89.5%) with modified Rankin Scale assessment at three months, no significant difference (p = 0.3) was found in the proportion of functionally independent individuals between groups 1 and 2 (51.8% versus 55.6%, respectively). Although statistical significance was not reached, our retrospective analysis exhibited a strong trend toward modified Thrombolysis in Cerebral Infarction first pass improvement when dwell time was increased from 2 to 5 min.

Impact of reperfusion pump power on technical and clinical outcomes after direct aspiration thrombectomy (ADAPT)

IntroductionHigher aspiration forces using larger bore catheters in direct aspiration thrombectomy (ADAPT) have been associated with shorter procedure time and better outcomes in patients treated for acute ischemic stroke (AIS)....