Large-bore Catheters Research Articles

Prolonged intracranial catheter dwell time exacerbates penumbral stress and worsens stroke thrombectomy outcomes

BackgroundThe duration of mechanical thrombectomy (MT) is a negative predictor of outcomes in acute ischemic stroke (AIS), yet the precise mechanisms are unclear. We investigated whether the placement of large-bore...

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.

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.

Clinical Outcome Using Different Catheter Interventional Treatment Modalities in High-Risk Pulmonary Artery Embolism.

For patients with high-risk pulmonary artery embolism (PE), catheter-directed therapies pose a viable alternative treatment option to systemic thrombolysis or anticoagulation. Right now, there are multiple devices available which have been proven to be safe and effective in lower-risk settings. There is, however, little data comparing their efficacies in high-risk PE. We performed a retrospective, single-center study on patients with high-risk PE undergoing catheter interventional treatment. Patients receiving large-bore catheter thrombectomy were compared to patients receiving alternative treatment forms. Of the 20 patients included, 9 received large-bore thrombectomy, and 11 received alternative interventional treatments. While the baseline characteristics were comparable between the two groups, periprocedural and in-hospital mortality tended to be significantly lower with large-bore thrombectomy when compared to other treatment forms (0 vs. 55% and 33 vs. 82%, p = 0.07 and 0.01, respectively). In this small, retrospective study, large-bore thrombectomy was associated with lower mortality as compared to alternative treatment forms. Future prospective research is needed to corroborate these findings.

First multicenter study evaluating the utility of the BENCHMARKTM BMXTM 81 large-bore access catheter in neurovascular interventions.

This study is the first multicentric report on the safety, efficacy, and technical performance of utilizing a large bore (0.081″ inner diameter) access catheter in neurovascular interventions. Data were retrospectively collected from seven sites in the United States for neurovascular procedures via large bore 0.081″ inner diameter access catheter (Benchmark BMX81, Penumbra, Inc.). The primary outcome was technical success, defined as the access catheter reaching its target vessel. Safety outcomes included periprocedural device-related and access site complications. There were 90 consecutive patients included. The median age of the patients was 63 years (IQR: 53, 68); 53% were female. The most common interventions were aneurysm embolization (33.3%), carotid stenting (12.2%), and arteriovenous malformation embolization (11.1%). The transradial approach was most used (56.7%), followed by transfemoral (41.1%). Challenging anatomic variations included severe vessel tortuosity (8/90, 8.9%), type 2 aortic arch (7/90, 7.8%), type 3 aortic arch (2/90, 2.2%), bovine arch (2/90, 2.2%), and severe angle (<30°) between the subclavian artery and target vessel (1/90, 1.1%). Technical success was achieved in 98.9% of the cases (89/90), with six cases requiring a switch from radial to femoral (6.7%) and one case from femoral to radial (1.1%). There were no access site complications or complications related to the 0.081″ catheter. Two postprocedural complications occurred (2.2%), unrelated to the access catheter. The BMX™ 81 large-bore access catheters was safe and effective in both radial and femoral access across a wide range of neurovascular procedures, achieving high technical success without any access site or device-related complications.

Matched-pair analysis of patients with ischemic stroke undergoing thrombectomy using next-generation balloon guide catheters

BackgroundBalloon guide catheters (BGCs) have not been widely adopted, possibly due to the incompatibility of past-generation BGCs with large-bore intermediate catheters. The next-generation BGC is compatible with large-bore catheters. We...

Efficacy and Safety of a New Delivery Assist Catheter with a Flexible, Spindle-Shaped Shaft in Mechanical Thrombectomy

Large-bore aspiration catheters (ACs) are used successfully in mechanical thrombectomy (MT). However, tortuous access routes prevent device navigation because of the ledge effect. The AXS Offset Delivery Assist Catheter is designed to reduce the ledge effect. The purpose of this study was to evaluate whether the Offset affects AC navigation compared with standard inner microcatheters in MT. We retrospectively investigated 75MTs for anterior circulation occlusion between January 2018 and May 2022 at our hospital. All MTs were performed using an AC, and 2 types of inner microcatheter (Offset or 0.021-0.027-inch standard microcatheter) were chosen randomly during AC navigation. The patients' characteristics, MT techniques, angiographic findings, and clinical outcomes were compared between the Offset and standard group (Non-Offset). The puncture to first pass of the lesion time was investigated to compare the characteristics of the inner catheters. The Offset group comprised 12 patients versus 63 in the Non-Offset group. Although most baseline clinical characteristics and outcomes were similar between the groups, the puncture to first pass of the lesion time was significantly shorter in the Offset versus Non-Offset group (31±10 vs. 46±24minutes, respectively; P=0.032). In the Offset group, all stent retrievers were deployed via the Offset. One artery dissection and 8 symptomatic intracranial hemorrhages occurred in the Non-Offset group; no complications occurred in the Offset group. The AXS Offset delivery assist catheter permitted faster and safer navigation of various ACs to the occlusions compared with standard delivery microcatheters in MT.

A novel technique of percutaneous transhepatic treatment of biliary-enteric anastomotic occlusive strictures with compliant balloon-occluded distal cholangiography and large-bore catheter: a retrospective case series.

Endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary balloon dilatation (PTBD) is a challenge in resolving biliary-enteric anastomotic occlusive strictures (BEAOS) and/or coexisting stones. The biliary-enteric anastomosis (BEA) often cannot be seen because of the surgically altered gastrointestinal anatomy. Here, a technique that combined percutaneous compliant-occluded distal cholangiography and the maintenance of a large-bore catheter is described to resolve this issue. A retrospective review of 10 patients who presented with BEAOS with/without coexisting stones who were treated with percutaneous compliant balloon-occluded distal cholangiography, bile duct stone removal, and the maintenance of a large-bore catheter between February 2017 and January 2021 was performed. Treatment response, laboratory examinations, including hepatic function tests, routine blood tests, and blood electrolytes, complications, and imaging data were evaluated. Paired t-tests were used to investigate the difference of laboratory examinations before and after the procedure. All 10 cases were technically successful. A total of 9 stones in 6 patients were successfully removed by the compliant balloon. All catheters were removed after the patency of the stricture was confirmed by percutaneous transhepatic cholangiography (PTHC) 6 months later. No severe adverse events occurred during the perioperative period. There were 2 patients who experienced episodes of cholangitis during the follow-up period (mean, 17 months; range, 4-24 months), and neither BEAOS nor bile duct stones recurred within 2 years after the procedure. White blood cells (WBC), total bilirubin (TB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were (6.0±1.4)×109/L and (6.0±1.6)×109/L (P=0.91), 31.4±15.7 and 29.6±10.3 µmol/L (P=0.74), 50.8±20.0 and 85.8±67.0 U/L (P=0.16), and 42.6±15.2 and 71.8±44.9 U/L (P=0.09) pre and postintervention, respectively. Percutaneous transhepatic compliant balloon-occluded distal cholangiography and the maintenance of a large-bore catheter probably provide an effective and safe alternative method for resolving BEAOS and/or coexisting stones.

Factors improving intravenous fluid flow rate for rapid resuscitation, based on the Hagen-Poiseuille law

Primary approach to the resuscitation of critical patients, in the emergency setting, requires a swift establishment of 2 large-bore peripheral intravenous catheters (PIVC) access accompanied by rapid fluid administration. This preferred use of a PIVC over a central venous catheter (CVC) stem from its ability to achieve faster fluid delivery, due its larger radius and shorter length. This is explained by the Hagen-Poiseuille Law whereby doubling the radius can increase flow 16-fold, and halving the length can double the flow. The law was applied in this experiment for the I.V tubing system itself. The results demonstrated that the 4mm I.D tube achieved the highest flow rates under both gravity and compression with a p-value of 0.009. Despite the Hagen-Poiseuille Law favoring shorter lengths, the 30 cm length resulted in the slowest flow rates. As emphasis is held on the importance of circulation in rapid resuscitation, ideal fluid delivery instruments specifically designed for volume-depleted patients need to be sought.

Vascular Complications in Transcatheter Aortic Valve Replacement With Plug-Based vs Suture-Based Closure Devices.

There are conflicting data regarding the efficacy and safety of suture vs plug-based vascular closure devices (VCDs) for large-bore catheter management in patients undergoing transcatheter aortic valve replacement (TAVR). We compared the rates of vascular complications (VCs) associated with 2 commonly used VCDs in a large cohort of patients undergoing TAVR. We conducted a single-centre, all-comer, prospective registry study, enrolling patients undergoing TAVR for symptomatic severe aortic stenosis (AS) between the years 2009 and 2022. Clinical outcomes were compared between patients undergoing closure of the femoral access point using the MANTA VCD (M-VCD) (Teleflex, Wayne, PA) vs the ProGlide VCD (P-VCD) (Abbott Vascular, Abbott Park, IL). The main outcome measures were researcher adjudicated events of VARC-2 defined major and minor VCs. Overall, 2368 patients were enrolled in the registry; 1315 (51.0% male, 81.0 ± 7.0 years) patients were included in the current analysis. P-VCD was used in 813 patients, whereas M-VCD was used in 502 patients. In-hospital VCs were more frequent in the M-VCD vs the P-VCD group (17.3% vs 9.8%; P < 0.001). This outcome was mainly driven by elevated rates of minor VCs in the M-VCD group, whereas no significant difference was observed for major VCs (15.1% vs 8.4%; P < 0.001 and 2.2% vs 1.5%; P= 0.33, respectively). In patients undergoing TAVR for severe AS, M-VCD was associated with higher rates of VCs. This outcome was mainly driven by minor VCs. The rate of major VCs was low in both groups.

Improved first-pass effect in acute stroke thrombectomy using Solitaire-X compared to Solitaire-FR.

In acute ischemic stroke (AIS), successful endovascular thrombectomy (EVT) of large vessel occlusion (LVO) necessitates the most suited device. Solitaire-X has longer and larger diameter pusher wires than Solitaire-FR.As the role of a larger pusher-wire diameter is uncertain, we aim to compare procedural, clinical, and radiological outcomes for AIS patients undergoing EVT using either type of Solitaire device. Procedures were performed using the Solumbra technique, which combines a large-bore aspiration catheter with a stentriever. The primary outcome was to compare rates of successful first-pass recanalization (defined as TICI 2b/3 score). The secondary objectives were procedural (rates of successful recanalization), clinical (post-procedural NIHSS and days of hospitalization), and radiological (post-procedural ASPECT score and hemorrhagic transformation) outcome measures. Consecutive AIS patients undergoing EVT for LVO were recruited into a prospective multicenter database at our academic center. We have used Solitaire-FR until October 2020 and Solitaire-X ever since. We retrospectively analyzed our prospective consecutive registry. Included in our analysis are patients undergoing EVT using Solitaire only; patients with tandem lesions or underlying stenosis requiring emergent stenting during the procedure were excluded. The cohort of patients treated with Solitaire-X was compared with a cohort consisting of the most recent consecutive cases undergoing EVT with the Solitaire-FR. A total of 182 (71.9 ± 14, 61% male patients) AIS patients were included in the analysis with both groups (n = 91 each) sharing similar demographic characteristics, premorbid conditions, and stroke characteristics (time from symptom-onset, NIHSS, ASPECTS, occlusion site, and rates of intravenous-tPA treatment). The Solitaire-X group had a higher rate of first-pass recanalization (65.9% vs. 50.5%, p = 0.049). On 24-h post-procedural head-CT, the Solitaire-X group had higher ASPECT scores (6.51 ± 2.9 vs. 5.49 ± 3.4, p = 0.042) and lower post-procedural average bleeding volumes (0.67 ± 2.1 vs. 1.20 ± 3.4 mL, p = 0.041). The Solitaire-X group had shorter duration of hospitalization (16.6 ± 13.1 days vs. 25.1 ± 23.2, p = 0.033). On multivariate analysis, using Solitaire-X was the sole independent predictor of first-pass recanalization (OR 2.17, 95% CI 1.12-4.26, p = 0.023). In our study, the use of the Stentriever-X with a larger pusher-wire diameter was associated with a higher likelihood of first-pass effect and improved procedural, clinical, and radiological outcomes in AIS patients.

Pigtail Catheter versus Large Bore Chest Tube for the Management of Spontaneous Pneumothorax in Children: A Retrospective Study.

Pigtail catheter (PGC) insertion due to spontaneous pneumothorax (SPT) in the pediatric population has increased markedly in the last years. However, only few studies examined its efficacy in terms of length of hospitalization, rate of complications, and especially pain management comparing to large bore catheter (LBC) insertion. We sought to compare analgetic drug consumption, efficacy, and complication rate between PGC and LBC in children with SPT. This is a single-center retrospective study of pediatric patients that were admitted to the Schneider Children's Medical Center between 2013 and 2021 with a diagnosis of SPT. The following data were collected: type of drainage (PGC or LBC), duration of drainage, length of hospitalization, number of X-rays, complication rate, surgery during hospitalization, readmission due to SPT, and pain management. Seventeen PGC and 23 LBC were inserted in our study. No differences were noted in terms of hospitalization length, tube reposition or replacement, and recurrence of SPT between the groups. Patients with PGC underwent less X-rays comparing to the LBC group (3 X-rays vs. 5, median, p < 0.005). Oral analgesic use in terms of length of therapy was significantly lower in the PGC group than in the LBC group (1 vs. 3+ days, median, p < 0.05). There was no major complication in this cohort. PGC is an effective, safe, and less painful alternative compared with a LBC for the drainage of SPT in children.

CARD31: Novel Tubing Connectors Reduce ECMO Circuit Thrombosis

Background: Extracorporeal Membrane Oxygenator (ECMO) circuit thrombosis is a common complication that plagues the clinical management of patients receiving mechanical circulatory support. High doses of anticoagulation required to reduce circuit thrombus burden can increase hemorrhagic complication risk, yet concomitantly persistent circuit clots result in frequent circuit replacement. Prior studies have identified the tubing-connector junction as contributing over 80% of circuit clots. Analysis and alteration of this junction can optimize mechanical flow properties to reduce the overall clot burden. We have designed a novel connector to reduce or eliminate the primary source of ECMO circuit clots. Methods: Our study utilized a combination of ex vivo and in vivo evaluation of our novel tubing connectors in comparison to current connectors. Our novel connectors were designed for use with 3/8” tubing and created using injection molding (Fig 1). For ex vivo simulation, we created a flow loop with 3/8” tubing and alternated current and novel connectors. Heparinized porcine blood was perfused for 96 hours. For in vivo assessment, we cannulated four goats with arterial and venous large-bore catheters and created an ECMO circuit with an oxygenator per standard clinical practice. These circuits were run for varying time periods, ranging from 12h to 48h. After completion of blood perfusion in both experimental setups, connectors were excised from the circuits and inspected. Clots were quantified for presence and radial protrusion into the connector lumen, and compared across connector type. Results: In both ex vivo and in vivo configurations, the current connectors formed large clots. In contrast, novel connectors formed almost no clots (p<0.01). Ex vivo flow loops showed more than one clot per current connector (upstream and downstream), while novel connectors contained only a single clot amongst 9 connectors with no luminal protrusion (Fig 2). In vivo connectors (Fig 3) were analyzed using a grading system involving clot presence and luminal protrusion. Current connectors had a significantly higher clot presence score (p<0.01) and lumen protrusion score (p<0.01) than novel connectors. Summary: Novel ECMO tubing connectors significantly reduce clot burden and can be easily integrated into current clinical practice, suggesting they may make significant impact in clinical ECMO circuits. Substantial reduction in thrombogenicity has the potential to reduce the need for anticoagulation, thereby also reducing adverse hemorrhagic events.

Improved catheter delivery for aspiration thrombectomy using Tenzing 7 ledge reducing catheter and FreeClimb 70.

Previous comparative mechanical thrombectomy device trials reported a substantial crossover rate from first-line aspiration to stent-retriever thrombectomy. A specialized delivery catheter may help track large-bore aspiration catheters to target occlusions. We report our multicenter experience of aspiration thrombectomy of intracranial large vessel occlusions using the FreeClimbTM 70 and Tenzing® 7 delivery catheter (Route 92, San Mateo, CA). After local Institutional Review Board approval, we retrospectively reviewed the clinical, procedural, and imaging data of patients who underwent mechanical thrombectomy with the FreeClimb 70 and Tenzing 7. FreeClimb 70 was successfully delivered using Tenzing 7 to target occlusion in 30/30 (100%) patients (18 M1, 6 M2, 4 ICA-terminus, and 2 basilar artery occlusions), without the use of a stent-retriever for anchoring. In 21/30 (70%) cases, a leading microwire was not needed to advance the Tenzing 7 to the target. Median (interquartile range) time from groin puncture to first pass was 12 (interquartile range 8-15) minutes. Overall first pass effect, or first pass effect (modified thrombolysis in cerebral ischemia 2C-3), was achieved 16/30 (53%). For M1 occlusions, first pass effect was 11/18 (61%). Successful reperfusion (modified thrombolysis in cerebral ischemia ≥ 2B) was achieved in 29/30 (97%) cases after a median of 1 pass (interquartile range 1-3). Median groin puncture to reperfusion time was 16 (interquartile range 12-26) minutes. There were no procedural complications or symptomatic intracranial hemorrhage. Average improvement in National Institutes of Health Stroke Scale at discharge was 6.6 ± 7.1. There were three patient deaths (renal failure, respiratory failure, and comfort care). Initial data support the use of Tenzing 7 with FreeClimb 70 catheter for reliable access to rapid, effective, and safe aspiration thrombectomy of large vessel occlusions.

A Post-closure Technique Using a Single Perclose Device in the Removal of a Transfemoral Impella Catheter

Objective: A transfemoral Impella can substantially support patients with cardiogenic shock, and surgical closure has conventionally been used for the removal of large-bore catheters. However, while percutaneous closure is a prompt and minimally invasive technique, single Perclose post-closure outcomes remain to be evaluated. The present study evaluated the safety and efficacy of single Perclose post-closure in the removal of transfemoral Impella catheters.Methods: Of 37 patients supported by an Impella device, 25 patients (68%) were excluded due to a transsubclavian approach, an inability to wean, or primary surgical closure. We reviewed 12 patients (32%) receiving the single Perclose post-closure method. For percutaneous closure, we inserted a 0.035-inch guidewire through the side port of the Impella device and extracted the device while retaining the guidewire. Single Perclose was deployed with an additional maneuver as backup, such as second Perclose or surgical closure. The outcomes were defined according to the Valve Academic Research Consortium-2 criteria.Results: All patients had received the Impella CP due to cardiogenic shock. All patients received single/dual antiplatelets without oral anticoagulants. Percutaneous closure was successful in 11 patients (92%); the remaining patient was converted to surgical closure. The mean (range) procedural time was 8.0 (5.8–9.0) minutes. Major bleeding and vascular complications were observed only in the patient with surgical conversion (8.3%). No closure-site infection or closure-related limb ischemia was observed. All patients were discharged alive after the removal of the Impella device.Conclusion: Single Perclose post-closure is a promising closure method for removing a transfemoral Impella, but further investigations are needed.

Porównanie in vivo cewników aspiracyjnych o różnej średnicy u pacjentów z zawałem mięśnia sercowego z uniesieniem odcinka ST

WstępTrombektomia aspiracyjna jest zalecana jedynie u wybranych pacjentów z zawałem mięśnia sercowego z uniesieniem odcinka ST (&lt;i&gt;ST elevation myocardial infarction&lt;/i&gt; – STEMI). Analiza z wykorzystaniem optycznej tomografii koherencyjnej wykazała ograniczenia niektórych cewników aspiracyjnych w usuwaniu skrzepliny. Ponadto testy &lt;i&gt;in vitro&lt;/i&gt; wskazują na istotne różnice w ich skuteczności zależnie od konstrukcji końcówki dystalnej oraz wewnętrznej średnicy. Celem pracy jest porównanie skuteczności przezskórnej interwencji wieńcowej (&lt;i&gt;percutaneous coronary intervention&lt;/i&gt;&lt;i&gt;&lt;b&gt;&lt;/b&gt;&lt;/i&gt; – PCI) z zastosowaniem trombektomii aspiracyjnej oraz bez jej użycia, a także sprawdzenie skuteczności różnych cewników w zależności od ich wewnętrznej średnicy.Materiał i metodyBadaniem objęto 773 chorych ze STEMI: 586 chorych tylko po PCI (grupa Ctrl) oraz 187 chorych po PCI i trombektomii. Cewniki podzielono na te o dużym otworze (&lt;i&gt;large-bore&lt;/i&gt; – LB), zastosowane u 146 pacjentów (grupa LB), oraz te o wąskim otworze (&lt;i&gt;small-bore&lt;/i&gt; – SB) – u 41 pacjentów (grupa SB). Porównano perfuzję mięśnia sercowego, frakcję wyrzutową lewej komory (&lt;i&gt;left ventricular ejection fraction&lt;/i&gt; – LVEF) i długoterminową śmiertelność z jakiejkolwiek przyczyny. Analizę statystyczną oparto na nieparametrycznej analizie przeżycia ANOVA oraz Kaplana i Meiera.WynikiGrupy charakteryzowała stronniczość wyboru w odniesieniu do danych demograficznych oraz prezentacji angiograficznej zawału mięśnia sercowego. W porównaniu z grupą Ctrl grupy LB i SB były młodsze, prezentowały wolniejszy przepływ nasierdziowy i większy materiał zakrzepowy w klasyfikacji TIMI (Thrombolysis in Myocardial Infarction). W grupie SB, w porównaniu z grupą Ctrl, obserwowano nieistotny trend w kierunku gorszej perfuzji mięśnia sercowego. Grupa LB miała niższą LVEF przed wypisem w porównaniu z grupą Ctrl. Długoterminowa umieralność z przyczyn ogólnych była porównywalna we wszystkich grupach.WnioskiNie mamy wystarczających dowodów na to, że cewniki SB są mniej skuteczne. Pozytywną obserwacją jest fakt, że długoterminowa śmiertelność z jakiejkolwiek przyczyny w grupie pacjentów po trombektomii aspiracyjnej jest porównywalna z tą w grupie kontrolnej, wymaga ona jednak potwierdzenia w przyszłych badaniach.

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.

In Vitro Comparison of Several Thrombus Removal Tools.

Although the routine use of thrombus aspiration is not recommended, the thrombectomy technique still might be considered for a selected population of patients. Therefore, the assessment of the effectiveness of commercially available thrombectomy devices is still clinically relevant. Here, we present an in vitro comparison of several different types of catheters that can be used for thrombus aspiration or removal. Through the removal of 6 h and 24 h human blood clots in an in vitro model, four catheters were compared: the Launcher, Pronto V4, Vasco+ and the stent-retriever Catchview. The aspiration efficacy was expressed as a percentage of the initial thrombus weight. The effectiveness of the patient's aspiration was dependent on the time of thrombus formation and was significantly higher for a thrombus formed over 24 h (58.5 ± 26.5%) than for one formed over 6 h (48.0 ± 22.5%; p < 0.001). In the presented in vitro model, Pronto V4 and Launcher showed the highest efficiency. Large-bore aspiration catheters were found to be more effective than narrow-bore catheters or stent-retrievers in an in vitro model of thrombus removal. The thrombus aspiration efficacy increases with longer thrombus formation times.

Early Mobility for Antepartum Post VA-ECMO Patient with Non-Traumatic Spinal Cord Injury: A Case Report

<h3>Research Objectives</h3> To describe mobility progression of a post VA-ECMO non-traumatic spinal cord injured patient immediately antepartum with prolonged hospitalization. <h3>Design</h3> Cardiac arrest represents approximately 56.6% of complications in the immediate antepartum period where extracorporeal membrane oxygenation (ECMO)is indicated. ECMO cannulations include veno-arterial (VA), veno-venous (VV), and venous-arterial-venous (VAV), where large-bore catheters are placed into large vessels and connected to a circuit. A membrane oxygenator pumps blood to exchange oxygen and carbon dioxide. Spinal cord tumors develop inside the spinal canal and are intramedullary or extramedullary. They can impact motor and sensory neurons, triggering pain, loss of movement, sensory changes, and bowel and bladder dysfunction. Dichorionic diamniotic gestation occurs when each fetus has a separate placenta and amniotic sac. Mothers remain at increased risk of premature labor and delivery. <h3>Setting</h3> 746 bed university affiliated tertiary hospital. <h3>Participants</h3> 31-year-old Dominican obese female with spinal cord tumor at 25 weeks 5 days gestation with dichorionic diamniotic pregnancy. Placed on VA-ECMO following cardiac arrest secondary to massive pulmonary embolism. <h3>Interventions</h3> Physical therapy (PT) initiated in the intensive care unit (ICU) following VA-ECMO decannulation. Interventions included cognitive stimulation, positioning, bed mobility, strengthening, cycle ergometry, and out of bed tolerance. Sessions were 15-60 minutes and progressed following standard safety measures. <h3>Main Outcome Measures</h3> FSS-ICU, AM-PAC, and RASS scores; manual muscle strength; number of therapy sessions; and mechanical ventilation (MV) days. <h3>Results</h3> PTs collected data in the hospital-based setting. Patient demonstrated improvement on outcome measures, although statistical significance was not calculated. FSS-ICU from un-scorable to 8/35, AM-PAC from 6/24 to 7/24, RASS score from -5 to 0, manual muscle strength from 0/5 throughout to 3+/5 to 4-/5 in the upper extremities and 0/5 in the lower extremities by discharge. 15 total PT sessions, including 13 in the ICU. 5 mobility sessions while on MV. <h3>Conclusions</h3> PT was deemed safe, and patient demonstrated improved functional mobility . Additional research is warranted for this population, although this case may serve as a framework given lack of complex patients to compare protocols to. <h3>Author(s) Disclosures</h3> No disclosures.

Prioritizing direct heart procurement in organ donors after circulatory death does not jeopardize lung transplant outcomes.

Controlled donation after circulatory death (cDCD) has become a standard in liver, kidney, and lung transplantation (LTx). Based on recent innovations in exvivo heart preservation, heart transplant centers have started to accept cDCD heart allografts. Because the heart has very limited tolerance to warm ischemia, changes to the cDCD organ procurement procedures are needed. These changes entail delayed ventilation and prolonged warm ischemia for the lungs. Whether this negatively impacts lung allograft function is unclear. A retrospective analysis of cDCD lungs transplanted between 2012 and February 2022 at the Medical University of Vienna was performed. The heart+lung group consisted of cases in which the heart was procured by a cardiac team for subsequent normothermic exvivo perfusion. A control group (lung group) was formed by cases where only the lungs were explanted. In heart+lung group cases, the heart procurement team placed cannulas after circulatory death and a hands-off time, collected donor blood for exvivo perfusion, and performed rapid organ perfusion with Custodiol solution, after which the heart was explanted. Up to this point, the lung procurement team did not interfere. No concurrent lung ventilation or pulmonary artery perfusion was performed. After the cardiac procurement team left the table, ventilation was initiated, and lung perfusion was performed directly through both stumps of the pulmonary arteries using 2 large-bore Foley catheters. This study analyzed procedural explant times, postoperative outcomes, primary graft dysfunction (PGD), duration of mechanical ventilation, length of intensive care unit (ICU) stay, and early survival after LTx. A total of 56 cDCD lungs were transplanted during the study period. In 7 cases (12.5%), the heart was also procured (heart+lung group); in 49 cases (87.5%), only the lungs were explanted (lung group). Basic donor parameters were comparable in the 2 groups. The median times from circulatory arrest to lung perfusion (24minutes vs 13.5minutes; P=.002) and from skin incision to lung perfusion (14minutes vs 5minutes; P=.005) were significantly longer for the heart+lung procedures. However, this did not affect post-transplantation PGD grade at 0hours (P=.851), 24hours (P=.856), 48hours (P=.929), and 72hours (P=.874). At 72hours after transplantation, none of the lungs in the heart+lung group but 1 lung (2.2%) in lung group was in PGD 3. The median duration of mechanical ventilation (50hours vs 41hours; P=.801), length of ICU stay (8days vs 6days; P=.951), and total length of hospital stay (27days vs 25days; P=.814) were also comparable in the 2 groups. In-hospital mortality occurred in only 1 patient of the lung group (2.2%). Although prioritized cDCD heart explantation is associated with delayed ventilation and significantly longer warm ischemic time to the lungs, post-LTx outcomes within the first year are unchanged. Prioritizing heart perfusion and explantation in the setting of cDCD procurement can be considered acceptable.