Mechanical Aspiration Thrombectomy Research Articles

Referral and outcomes of mechanical thrombectomy for pulmonary embolism - a single-centre experience

Abstract Funding Acknowledgements None. Introduction Acute pulmonary embolism (PE) is a significant cause of morbidity and mortality, and percutaneous catheter-based treatments have emerged as an effective treatment option alongside thrombolysis. However, data concerning long-term outcomes are scarce. Methods All patients referred to a tertiary centre for pulmonary angiography with the intent to perform mechanical thrombectomy in the context of acute PE between January 2016 and August 2023 were retrospectively included and clinical data and outcomes were collected. Results Fifty-two patients (58% female; mean age 66±18 years) were referred to pulmonary angiography in the setting of acute PE, of whom 40 patients (77%) underwent continuous aspiration mechanical thrombectomy with an overall success rate of 70%. Twenty-eight percent of patients had bilateral thrombus. Thirty-two patients had intermediate-high risk or high-risk PE, and the mean Pulmonary Embolism Severity Index (PESI) was 146 points. Thirteen patients (25%) underwent thrombolysis prior to angiography, while 15 patients (28%) had an absolute or relative contraindication for thrombolysis. Ventilation/perfusion scans were performed in ten patients (19%) during the follow-up period, of whom five patients (10%) had evidence of residual illness, with no significant differences between the thrombectomy and non-thrombectomy groups (p=0.8). The overall mortality rate over the complete follow-up period was 39%, while 25% of patients died within 48 hours of the procedure. Predictors of mortality on univariate analysis included older age (HR 1.06 [95% CI 1.00-1.11, p = 0.03]), history of chronic obstructive pulmonary disease (HR 3.88 [95% CI 1.41-10.69, p = 0.01]), history of previous deep vein thrombosis or PE (HR 3.40 [95% CI 1.34-8.63, p = 0.01]), thrombolysis prior to referral for mechanical thrombectomy (HR 5.94 [95% CI 1.93-18.26, p <0.01), shock or haemodynamic instability (HR 8.50 [95% CI 2.44-29,52, p <0.01]) and resuscitated cardiac arrest (HR 5.98 [95% CI 2.34-15.30, p <0.01]). On Cox multivariate analysis, the presence of shock or haemodynamic instability was a predictor of increased mortality (HR 5.23 [95% CI 1.12-24.3, p = 0.04]). Conclusions Intermediate and high risk acute PE is a clinical entity with a high morbidity and mortality rate regardless of treatment strategy, particularly during the index hospitalization and in patients with shock or haemodynamic instability.

Outcomes With Hybrid Catheter-Directed Therapy Compared With Aspiration Thrombectomy for Patients With Intermediate-High Risk Pulmonary Embolism.

Intermediate-high-risk pulmonary embolism (IHR PE) is a challenging form of embolism obstruction that causes right ventricular(RV) dysfunction. The optimal management of IHR PE has not been established. This single-center prospective, observational study aimed to evaluate the efficacy and safety of complex catheter-directedtherapy (CDT)-catheter-directed mechanical aspiration thrombectomy (CDMT) supplemented with catheter-directed thrombolysis (hybrid CDT)in comparison to CDMT alone for IHR PE. A propensity score based on the pulmonary embolism severity index class and Miller obstruction index (MOI) was calculated, and 21 hybrid CDT cases (mean age 54.8 (14.7) years, 9/21 women) were matched with 21 CDMT cases (mean age 58.8 (14.9) years, 13/21 women). The baseline demographics, clinical,and treatment characteristics were analyzed. No significant differences were detected regarding baseline demographics and PE severity parameters. Hybrid CDT demonstrated a higher reduction in mean pulmonary artery pressure (mPAP) (hybrid CDT: median mPAP reduction 8mmHg (IQR: 6-10mmHg) vs CDMT: median mPAP reduction 6mmHg (IQR: 4-7mmHg); P = 0.019), MOI score (hybrid CDT: median change - 5 points (IQR: 5-6 points) vs CDMT median change - 3 points (IQR: 3-5 points); P = 0.019), and median RV: left ventricular ratio (hybrid CDT: median change 0.4 (IQR: 0.3-0.45) vs CDMT median change 0.26 (IQR: 0.2-0.4); P = 0.007). No major bleeding was observed. Both the hybrid CDT and CDMT alone treatments are safe and effective in managing IHR PE. Hybrid CDT is a promising technique for the management of IHR PE with insufficient thrombus load reduction by CDMT. NCT0447356-registration date 16 July 2020.

A cross-sectional study of outcomes for patients undergoing mechanical thrombectomy for pulmonary embolism during 2018-2022: Insights from the PINC AI Healthcare Database.

Mechanical thrombectomy (MT) treatments for pulmonary embolism (PE) have yet to be compared directly. We aimed to determine if patient outcomes varied following treatment of PE with different MT devices. All PE encounters with an index treatment of MT between January 2018 and March 2022 were analyzed for in-hospital mortality, discharge to home, and 30-day readmission outcomes in the PINC AI™ Healthcare Database. MT devices used in each encounter were extracted from hospital charge description free-text fields using keyword text and fuzzy matching. Unadjusted and adjusted logistic regression was used to model outcomes by device. A total of 5893 encounters were identified using MT as the sole index PE treatment and 1812 using MT with another treatment. Of these, 41% had insufficient information to identify the devices used (unspecified MT), 33% used the FlowTriever System (large-bore volume-controlled aspiration MT), 23% the Indigo System (continuous aspiration MT), and 3% some other MT. Large-bore volume-controlled aspiration MT was used with other treatments 13% of the time compared with 23% and 39% for unspecified MT and continuous aspiration MT, respectively. Adjusted logistic regression modeling revealed the odds of in-hospital mortality were significantly higher for patients treated with unspecified MT ([OR] = 1.42, 95% confidence interval [CI]: [1.10-1.83], p = 0.008) or continuous aspiration MT (OR = 1.63, 95% CI: [1.21-2.19], p = 0.001) compared with large-bore volume-controlled aspiration MT. Discharge to home was significantly lower in these same groups (OR = 0.84, 95% CI: [0.73-0.96], p = 0.01, and OR = 0.63, 95% CI: [0.53-0.74], p < 0.001, respectively), but readmission risks at 30 days were comparable (OR = 1.08, 95% CI: [0.84-1.38], p = 0.56, and OR = 1.20, 95% CI: [0.89-1.62], p = 0.24, respectively). PE outcomes and treatment patterns differ significantly based on the type of MT utilized. Clinical studies directly comparing MT treatments are needed to further understand optimal treatment of PE.

Syringe-assisted test-aspiration with mechanical aspiration thrombectomy results in good safety and short-term outcomes in the treatment of patients with deep venous thrombosis.

To evaluate the short-term outcomes and safety of syringe-assisted test-aspiration with mechanical aspiration thrombectomy in the treatment of deep venous thrombosis. This was a single-center, retrospective study of hospitalized patients with iliofemoral and/or inferior vena caval deep venous thrombosis, excluding those with pulmonary embolism. We collected the following patient data from the electronic medical records: age, sex, provoked/unprovoked deep venous thrombosis, symptom duration, thrombosed segments, and the presence of a tumor, thrombophilia, diabetes, and/or iliac vein compression syndrome. Venography and computed tomographic venography were performed in all patients before the procedure. All patients underwent syringe-assisted test-aspiration with mechanical aspiration thrombectomy under local anesthesia and sedation, and all received low-molecular-weight heparin peri-operatively. All patients underwent implantation of an inferior vena caval filter. Rivaroxaban was administered post-procedure, instead of heparin, for 3-6 months, with lower extremity compression. Overall, 29 patients with deep venous thrombosis underwent syringe-assisted test-aspiration with mechanical aspiration thrombectomy from January 2022 to October 2022 in our institution. Technical success (>70% thrombus resolution) was achieved in all patients, and using a single procedure in 25/29 patients (86%). Concomitant stenting was performed in 18/29 (62%) of the patients, and 21/29 (69%) underwent angioplasty. The median (interquartile range) procedure time was 110min (100-122), the median intra-operative bleeding volume was 150mL (120-180), and the median decrease in the hemoglobin concentration from pre- to post-operative was 7g/L (4-14). The median follow-up duration was 7 months (5-9). All patients obtained symptomatic relief, and 27/29 achieved near-remission or full remission (combined total). No patients experienced peri-operative bleeding complications, or symptom recurrence or post-thrombectomy syndrome during follow-up. The short-term outcomes following syringe-assisted test-aspiration with mechanical aspiration thrombectomy in the treatment of deep venous thrombosis were excellent, and the procedure was safe.

Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia: Presented at the Forty-fifth Annual Charing Cross Symposium (CX), London, UK, April 25-27, 2023.

Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia: Presented at the Forty-fifth Annual Charing Cross Symposium (CX), London, UK, April 25-27, 2023.

Short-term outcomes of endovascular management of acute limb ischemia using aspiration mechanical thrombectomy.

Management of acute limb ischemia (ALI) has seen greater utilization of catheter-based interventions over the last two decades. Data on their efficacy is largely based on comparisons of catheter-directed thrombolysis (CDT) and open thrombectomy. During this time, many adjuncts to CDT have emerged with different mechanisms of action, including pharmacomechanical thrombolysis (PMT) and aspiration mechanical thrombectomy (AMT). However, the safety and efficacy of newer adjuncts like AMT have not been well established. This study is a retrospective analysis of the contemporary management of ALI comparing patients treated with aspiration mechanical thrombectomy to patients treated with the more established CDT adjunct, pharmacomechanical thrombolysis. Patients undergoing peripheral endovascular intervention for ALI using an adjunctive device were identified through query of the Vascular Quality Initiative (VQI) Peripheral Vascular Intervention (PVI) module from 2014 to 2019. Patients with a nonviable extremity (Rutherford ALI Stage 3), prior history of ipsilateral major amputation, popliteal aneurysm, procedures that were deemed elective (>72h from admission), procedures that did not utilize an endovascular adjunctive device, and patients without short-term follow-up were all excluded from analysis. The primary outcome was a composite outcome of freedom from major amputation and/or death in the perioperative time period. We identified 528 patients with Rutherford ALI Stage 1 or 2 who were treated with an endovascular adjunct. 433 patients did not undergo aspiration mechanical thrombectomy (no AMT group) and 95 patients did undergo aspiration mechanical thrombectomy (AMT group). The amputation-free survival across all patients was 93.4%. There were significant differences in demographic, comorbidity, and treatment variables between groups (e.g., gender, prior percutaneous coronary intervention (PCI), history of prior peripheral artery disease intervention, and history of prior infra-inguinal PVI), so a propensity score matched analysis was included to account for these group differences. In the propensity score matched analysis, there was no significant difference in major amputation (AMT 7.4% vs no AMT 3.2%, p = 0.13) or death (AMT 95.8% survival vs no AMT 98.4% survival, p = 0.23) with the use of aspiration mechanical thrombectomy. However, there was significantly worse amputation-free survival with the use of aspiration mechanical thrombectomy (AMT 88.4% vs no AMT 95.3%, p = 0.03). On multivariate analysis, prior supra-inguinal bypass (OR 4.85, 1.70-13.84, p = 0.003), Rutherford ALI Stage 2B (OR 3.13, 1.47-6.67, p = 0.003), and aspiration mechanical thrombectomy (OR 2.71, 1.03-7.17, p = 0.05) were associated with the composite outcome. Short-term amputation-free survival rates of endovascular management of acute limb ischemia are adequate across all modalities. However, aspiration mechanical thrombectomy was associated with significantly worse amputation-free survival compared to other endovascular adjuncts alone (i.e., pharmacomechanical thrombolysis). Severe limb ischemia (Rutherford ALI Stage 2B) and prior supra-inguinal bypass were associated with worse amputation-free survival regardless of the choice of endovascular intervention.

Use of the Indigo CAT RX aspiration system during percutaneous coronary intervention.

The use of the Indigo CAT RX Aspiration System (Penumbra Inc.) during percutaneous coronary intervention has received limited study. We retrospectively examined the clinical, angiographic, and procedural characteristics, outcomes, and follow-up of patients who underwent mechanical aspiration thrombectomy with the Indigo CAT RX system (Penumbra Inc.) at a large tertiary care hospital between January 2019 and April 2023. During the study period, 83 patients (85 lesions) underwent thrombectomy with the Indigo CAT RX. Mean patient age was 64.9 ± 14.48 years and 31.2% were women. The most common presentations were ST-segment elevation myocardial infarction (MI) (66.2%) and non-ST-segment elevation MI (26.5%). A final thrombolysis in MI flow grade of 3 and final myocardial blush grade of 3 were achieved in 76% and 46% of the cases, respectively. Technical success was achieved in 88.9% of the cases that included Indigo CAT RX treatment only, compared with 57.1% of the cases that also included manual aspiration. There were no device-related serious adverse events. At 30-day postprocedure, the incidence of major adverse cardiac events (composite of cardiovascular death, recurrent MI, cardiogenic shock, new or worsening New York Heart Association Class IV heart failure, stroke) was 8.5%: 1.3% stroke (postprocedure, in-hospital), 1.3% MI, 6.1% cardiac death, and 7.5% developed cardiogenic shock. Use of the Indigo CAT RX system is associated with high technical success and acceptable risk of complications, including stroke.

Tenzing 7 delivery catheter with or without a leading microwire for single pass aspiration thrombectomy: A multicenter experience.

Aspiration mechanical thrombectomy traditionally includes use of an inner microcatheter and leading microwire to navigate an aspiration catheter (AC) to the site of occlusion. Early clinical experience suggests that a leading microwire is often not needed with the Tenzing 7 (T7, Route 92 Medical, San Mateo, CA), a soft tapered tip ledge-reducing delivery catheter. This multicenter experience aims to describe AC delivery success in single-pass thrombectomy using T7 with and without a leading microwire. A retrospective review was conducted of consecutive patients who underwent single-pass thrombectomy with T7 at six institutions between 2020 and 2022. We examined the percentage of successful AC delivery, puncture-to-revascularization time, and procedural complication rate. A leading microwire with T7 was used in 19/89 (21%) of patients, and it was not used with T7 in 70/89 (79%) of patients. Successful AC delivery was similar with and without microwires (97% vs. 90%, p = 0.15). Median puncture-to-revascularization times were similar (17 min microwire vs. 16 min no-microwire, p = 0.12). No complications were associated with microwire use; one (1.4%) patient had a T7-related vasospasm resolved with verapamil during thrombectomy without a leading microwire. Differences in complication rates were not statistically significant (p = 0.46). In our real-world clinical experience, leading microwire use was infrequently necessary with the T7 delivery catheter. Successful AC delivery and complication rates were similar with and without microwire use in single-pass T7 thrombectomies. Initial pass with T7 may be performed without use of leading microwire, reserving microwire use for refractory cases or known difficult-to-navigate vasculature.

Safety and efficacy of mechanical aspiration thrombectomy for patients with acute lower extremity ischemia

ObjectiveAcute limb ischemia (ALI) is associated with high rates of amputation and consequent morbidity and mortality. The objective of this study is to report on the safety and efficacy of aspiration thrombectomy using the Indigo Aspiration System in patients with lower extremity (LE) ALI. MethodsThe STRIDE study was an international, multicenter, prospective, study that enrolled 119 participants presenting with LE-ALI. Patients were treated firstline with mechanical thrombectomy using the Indigo Aspiration System, before stenting or angioplasty, or other therapies as determined by treating physician. The primary end point was target limb salvage at 30 days after the procedure. Secondary end points within 30 days included technical success, defined as core laboratory-adjudicated Thrombolysis in Myocardial Infarction (TIMI) 2/3 flow rate immediately after the procedure, changes in modified Society for Vascular Surgery runoff score, improvement of Rutherford classification compared with before the procedure, patency, rate of device-related serious adverse events, and major periprocedural bleeding. Secondary end points that will be evaluated at 12 months include target limb salvage and mortality. ResultsOf the 119 participants enrolled at 16 sites, the mean age was 66.3 years (46.2% female). At baseline (n = 119), ischemic severity was classified as Rutherford I in 10.9%, Rutherford IIa in 54.6%, and Rutherford IIb in 34.5%. The mean target thrombus length was 125.7 ± 124.7 mm. Before the procedure, 93.0% (of patients 107/115) had no flow (TIMI 0) through the target lesion. The target limb salvage rate at 30 days was 98.2% (109/111). The rate of periprocedural major bleed was 4.2% (5/119) and device-related serious adverse events was 0.8% (1/119). Restoration of flow (TIMI 2/3) was achieved in 96.3% of patients (105/109) immediately after the procedure. The median improvement in the modified Society for Vascular Surgery runoff score (before vs after the procedure) was 6.0 (interquartile range, 0.0-11.0). Rutherford classifications also improved after discharge in 86.5% of patients (83/96), as compared with preprocedural scores. Patency at 30 days was achieved in 89.4% of patients (101/113). ConclusionsIn the STRIDE (A Study of Patients with Lower Extremity Acute Limb Ischemia to Remove Thrombus with the Indigo Aspiration System) study, aspiration thrombectomy with the Indigo System provided a safe and effective endovascular treatment for patients with LE-ALI, resulting in a high rate (98.2%) of successful limb salvage at 30 days, with few periprocedural complications.

Aristotle‐Only Direct Aspiration First‐Pass Technique (AO‐ADAPT) for Endovascular Mechanical Thrombectomy: A Technical Series of a Novel Technique Demonstrating Safety and Efficacy

Background The introduction of soft, large‐profile microwires has improved aspiration catheter delivery for intracranial large‐vessel occlusions. The Aristotle‐only direct aspiration first‐pass technique (AO‐ADAPT) uses the Aristotle 24 microwire to deliver a large‐bore aspiration catheter to the target occlusion without a microcatheter. We characterized rates of technical success achieved using this technique for mechanical aspiration thrombectomy. Methods A retrospective review of prospectively collected thrombectomy databases at 4 academic institutions identified patients undergoing procedures in which AO‐ADAPT was used. Patient demographics, clinical considerations, technical details, and radiographic outcomes were collected. Rates of successful aspiration catheter delivery without adjunctive devices and of successful reperfusion (Thrombolysis in Cerebral Infarction≥2B) were collected. Results Forty‐five patients met inclusion criteria (mean age 72.2±13.2 years, 62.2% female; 71.1% M1 occlusions). With a first‐line AO‐ADAPT approach, 42/45 (93.3%) patients achieved Thrombolysis in Cerebral Infarction≥2B reperfusion, with first‐pass recanalization in 26/45 (57.8%). We delivered the aspiration catheter to the target occlusion without adjunctive device in 35/45 (77.8%) patients. Of these, 29 (82.9%) underwent successful contact aspiration. This entire cohort (64.4% of the population) achieved Thrombolysis in Cerebral Infarction≥2B, with a mean time to reperfusion of 16 minutes and a first‐pass recanalization rate of 66%. Of the 16 patients who did not achieve successful AO‐ADAPT reperfusion, 6 needed a microcatheter for aspiration catheter delivery but underwent successful contact aspiration, 6 achieved microcatheter‐free delivery but needed a stentriever for final recanalization, and 4 required both microcatheter for delivery and stentriever for final recanalization. No intracranial vascular complications occurred during the procedures; 1 patient (2.2%) experienced symptomatic intracranial hemorrhage secondary to reperfusion injury. Conclusion The AO‐ADAPT approach to mechanical thrombectomy safely and effectively achieved reperfusion for patients with large‐vessel occlusions, with first‐pass success and successful recanalization rates comparable with other techniques. For most cases in this series, this technique obviated the need for a microcatheter and/or stentriever.

Novel Tenzing 7 Delivery Catheter for Thrombectomy in Acute Stroke: A Clinical Multicenter Experience

Background Preliminary in vitro and early clinical experience of the Tenzing 7 delivery catheter demonstrated high success rates of aspiration catheter intracranial delivery with minimal complications. This study aimed to examine the efficacy, safety, and efficiency of the Tenzing 7 delivery catheter to deliver therapeutic devices in aspiration mechanical thrombectomy for acute ischemic strokes using clinical experience from multiple institutions. Methods We performed a retrospective analysis of prospectively collected data from patients with acute ischemic stroke treated with aspiration mechanical thrombectomy using the Tenzing 7 delivery catheter between January 2020 and July 2022 at 6 high volume stroke centers. Primary efficacy outcome was success in aspiration catheter delivery to the face of the thrombus, and primary safety end point was rate of procedural complication. Results Of a total of 176 patients (mean age 70.1±14.9 years, 56.3% female, 89.2% middle cerebral artery occlusions), first‐pass effect (modified Thrombolysis in Cerebral Infarction score≥2B) was achieved in 90/166 (54.2%) successfully revascularized patients. Tenzing 7 delivered the aspiration catheter of choice to the site of occlusion in 95.9% of cases; the clot was not crossed with Tenzing 7 in 69% of cases. Successful recanalization (modified Thrombolysis in Cerebral Infarction score≥2B) was achieved in 94.9% of cases requiring a median of 1 pass (interquartile range 1–3). Nonflow limiting vessel dissection unrelated to Tenzing 7 occurred in 4 patients (2.3%), and intracranial vessel perforation unrelated to Tenzing 7 occurred in 4 cases (2.3%). Conclusion This multicenter clinical experience using Tenzing 7 in mechanical thrombectomy demonstrated high rates of technical success and a modest complication rate, similar to the published rates of technical success with other thrombectomy techniques. The Tenzing 7 delivery catheter is effective and safe for the delivery of the aspiration catheter in patients undergoing thrombectomy for acute ischemic stroke.

Effect of Baseline TIMI Thrombus Grade on Safety and Performance Outcomes in High Thrombus Burden Acute Coronary Syndrome Patients Treated With Sustained Mechanical Aspiration Thrombectomy Before Percutaneous Coronary Intervention: A Subset Analysis of the CHEETAH Study

Effect of Baseline TIMI Thrombus Grade on Safety and Performance Outcomes in High Thrombus Burden Acute Coronary Syndrome Patients Treated With Sustained Mechanical Aspiration Thrombectomy Before Percutaneous Coronary Intervention: A Subset Analysis of the CHEETAH Study

Mechanical Aspiration of a Heavy Thrombus in the Left Anterior Descending Artery using Penumbra Aspiration Catheter

Left anterior descending artery thrombosis is a medical emergency that requires prompt intervention to achieve the best possible clinical outcomes [1]. Early recanalization of obstructed vessels and thrombectomy with subsequent stenting effectively restore blood flow and improve procedural outcomes [2]. However, Manual Aspiration Thrombectomy (MAT) using a flexible aspiration catheter is also an alternative method that can be used to open blocked vessels [3]. Recent advancements in aspiration catheters have improved their trackability and size, making them comparable in efficacy to SBT [4]. As a result, Stent-Based Thrombectomy (SBT) and mechanical aspiration thrombectomy have become the primary treatment options for endovascular therapy in particular cases of coronary artery disease. The concurrent utilization of SBT and MAT as first-line and fallback interventions has been demonstrated to be effective in restoring vascular recanalization [5]. Besides SBT and MAT, a new aspiration catheter device has emerged. It is a relatively new technique for treating a thrombus in LAD that involves using a specialized catheter to remove the blood clot from the culprit artery [6]. This minimally invasive procedure is faster and more effective than traditional treatments such as thrombolytic therapy or Percutaneous Coronary Intervention (PCI) [7]. Penumbra medical technology company (Penumbra Inc, Alameda, CA, USA) introduced the Aspiration System in 2014 [8]. This system is specifically designed to remove blood clots from veins and arteries in the "peripheral vasculature" as well as for the treatment of "pulmonary embolism" [9]. The CAT family of catheters, developed by Penumbra, is known for its robustness, trackability, and atraumatic design, making it well-suited for peripheral anatomy where a thrombus forms [10]. The system comes equipped with the "Penumbra ENGINE aspiration source," which can administer almost untainted and consistent vacuum to catheters. This proficiency enables the extraction of thrombus in vessels of assorted dimensions. Recently, a penumbra aspiration catheter was used in a case report to remove thrombosis in acute coronary syndrome. According to the findings presented in this case report, it can be deduced that the Penumbra CAT RX catheter represents a secure and remarkably efficient alternative for eliminating blood clots in urgent scenarios. Notably, this method mitigates the heightened vulnerability to stroke often associated with the conventional approach of manual aspiration thrombectomy [11]. Previously, penumbra reperfusion catheter and MAT have been used as a "first-line therapy," and SBT with a "Solitaire stent" as a rescue therapy since 2012. This approach showed promising results regarding vessel recanalization and clinical outcomes [12].

Computer-aided Mechanical Aspiration Thrombectomy with the Indigo Lightning 12 Aspiration System for the Treatment of Acute Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study

Computer-aided Mechanical Aspiration Thrombectomy with the Indigo Lightning 12 Aspiration System for the Treatment of Acute Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study

Abstract No. 73 Computer-Aided Mechanical Aspiration Thrombectomy with the Indigo Lightning 12 Aspiration System for the Treatment of Acute Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study

Abstract No. 73 Computer-Aided Mechanical Aspiration Thrombectomy with the Indigo Lightning 12 Aspiration System for the Treatment of Acute Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study

CRT-100.31 Effect of Baseline TIMI Thrombus Grade on Safety and Performance Outcomes in High Thrombus Burden Acute Coronary Syndrome Patients Treated With Sustained Mechanical Aspiration Thrombectomy Before Percutaneous Coronary Intervention: A Subset Analysis of the CHEETAH Study

CRT-100.31 Effect of Baseline TIMI Thrombus Grade on Safety and Performance Outcomes in High Thrombus Burden Acute Coronary Syndrome Patients Treated With Sustained Mechanical Aspiration Thrombectomy Before Percutaneous Coronary Intervention: A Subset Analysis of the CHEETAH Study

Percutaneous mechanical pulmonary thrombectomy: An emerging opportunity for vascular surgeons

ObjectivePercutaneous pulmonary artery (PA) mechanical thrombectomy is a minimally invasive treatment for patients with submassive pulmonary emboli (PE). Recent registry data suggest that only approximately 12% of these procedures are being performed by vascular surgeons. We conducted a single center, 1-year, prospectively collected, retrospectively reviewed original study of all patients who had percutaneous PA aspiration mechanical thrombectomy (PPAAMT) performed by vascular surgeons to treat acute, submassive PE. MethodsBetween January 2020 and January 2021, 5 vascular surgeons performed 21 percutaneous PPAAMTs, representing 72% of all the PPAAMT performed at our institution. The remaining 28% were performed by interventional radiology and cardiology physicians (4 patients each). Vascular surgeons used the Inari Flowtriever aspiration catheter in 90.4% of our cases. For the remaining 10% of cases, the Penumbra Indigo thrombectomy device was used. Device choice was determined by the surgeon. ResultsWe analyzed prospectively collected data and reviewed postprocedural outcomes including PA mean arterial pressures, interval improvement of respiratory function, and mortality. Among the patients treated with PPAAMT by vascular surgeons in this series, 76% demonstrated an improvement in oxygen requirements and 83% saw an improvement in their post-thrombectomy PA mean arterial pressure. There were three mortalities (16%), none of which were procedure related or attributable to the patients' acute presentation or to PE recurrence. ConclusionsIn this prospectively collected, retrospectively analyzed original study, vascular surgeons performed the majority of percutaneous PPAAMT to treat submassive PE at a single institution, with no procedure-related mortality and a high rate of clinical improvement as measured by improvements in oxygen requirements and PA mean arterial pressures. These results suggest that PPAAMT performed by vascular surgeons is safe and effective and can be strategically incorporated into an already busy tertiary care vascular surgery practice.

Continuous mechanical aspiration thrombectomy performs equally well in main versus branch pulmonary emboli: A subgroup analysis of the EXTRACT-PE trial.

The EXTRACT-PE trial evaluated the safety and performance of the Indigo Aspiration System (PenumbraInc.) with an 8F continuous mechanical aspiration thrombectomy system for the treatment of pulmonary embolism (PE). This subgroup analysis evaluates performance outcomes of patients with main pulmonary artery (PA) emboli versus discrete unilateral or bilateral PA emboli without main PA involvement. The EXTRACT-PE trial was a prospective, single-arm, multicenter trial that enrolled 119 patients with acute submassive PE. Emboli location was collected at the time of enrollment, CT obstruction was measured and assessed by a Core Lab, and patients were grouped on whether emboli involved the main PA (with or without branch vessels) or not (branch vessels alone). Procedural device time, changes in the right ventricle to left ventricle (RV/LV) ratio, and systolic PA pressure from pre-and posttreatment were compared between the two groups. Out of the 119 patients enrolled, 118 had core lab-assessed clot locations. Forty-five(38.1%) had emboli that involved the main PA and 73 (61.9%) had only branch emboli. No significant difference was observed between these groups for 30-day mortality, procedural device time, changes in RV/LV ratio, reduction in CT Obstruction Index, or for systolic PA pressure from pre-and posttreatment. The mean absolute reduction in clot burden was significant in both groups. Continuous mechanical aspiration thrombectomy with the 8F Indigo Aspiration System was effective at improving clinical outcomes for submassive PE patients regardless of emboli location, and clot burden was significantly reduced in both groups.

Treatment Outcomes of Mechanical Thrombectomy in Patients with Acute Posterior Circulation Stroke.

Objective The benefits of mechanical thrombectomy (MT) in patients with acute posterior circulation stroke remain unclear. Currently, there is no evidence from randomized control trials to show the safety and effectiveness of MT in patients with posterior circulation stroke. This study was to evaluate the treatment outcomes of MT in posterior circulation stroke patients enrolling in our hospital during 2010 to 2020. Materials and Methods Between January 2010 and December 2020, 66 patients with acute posterior circulation stroke underwent MT. Data collected and analyzed included demographics, comorbidity, National Institutes of Health Stroke Scale (NIHSS), procedure time, site of occlusion, presence of posterior communicating artery (PCoA), endovascular technique, and modified Rankin Scale (mRS). Good clinical outcome was defined by mRS at 2 or less at 90 days after MT. Statistical Analysis Variables with normal distribution were reported with mean ± standard deviation, meanwhile those with nonnormal distribution were demonstrated with median and range. Fisher's exact test for categorical variables or Mann-Whitney U test for continuous variables was performed. Multivariate logistic regression analysis with binary logistic regression method was used analyze the association between the prognosis factor and good outcome. Statistical significance was defined when p -value less than 0.05. Results The mean age of patients was 65.2 years with male predominance. The median NIHSS was 18.5. Successful recanalization (modified thrombolysis in cerebral infarction 2b-3) was achieved in 61/66 cases (92.42%) and postprocedure symptomatic intracerebral hemorrhage occurred in 5/66 cases (7.60%). Successful recanalization with good clinical outcome was obtained from 30 of 61 cases (49.18%); it was also associated with distal basilar artery occlusion ( p = 0.035) and PCoA patency presence ( p = 0.024). Our study showed the correlation between good treatment outcomes with initial NIHSS less than 20, intravenous recombinant tissue-type plasminogen activator, pre-MT magnetic resonance imaging Q5 brain, and contact aspiration MT technique. Conclusion MT is beneficial to patients with posterior circulation stroke. A good clinical outcome was significantly associated with distal basilar artery occlusion and PCoA patency presence within a group of successful recanalization.

Mechanical aspiration thrombectomy for the treatment of pulmonary embolism: A systematic review and meta-analysis.

There are no randomized trials studying the outcomes of mechanical aspiration thrombectomy (MAT) for management of pulmonary embolism (PE). We performed a systematic review and meta-analysis of existing literature to evaluate the safety and efficacy of MAT in the setting of PE. Inclusion criteria were as follows: studies reporting more than five patients, study involved MAT, and reported clinical outcomes and pulmonary artery pressures. Studies were excluded if they failed to separate thrombectomy data from catheter-directed thrombolysis data. Databases searched include PubMed, EMBASE, Web of Science until April, 2021. Fourteen case series were identified, consisting of 516 total patients (mean age 58.4 ± 13.6 years). Three studies had only high-risk PE, two studies had only intermediate-risk PE, and the remaining nine studies had a combination of both high-risk and intermediate-risk PE. Six studies used the Inari FlowTriever device, five studies used the Indigo Aspiration system, and the remaining three studies used the Rotarex or Aspirex suction thrombectomy system. Four total studies employed thrombolytics in a patient-specific manner, with seven receiving local lysis and 17 receiving systemic lysis, and 40 receiving both. A random-effects meta-analyses of proportions of in-hospital mortality, major bleeding, technical success, and clinical success were calculated, which yielded estimate pooled percentages [95% CI] of 3.6% [0.7%, 7.9%], 0.5% [0.0%, 1.8%], 97.1% [94.8%, 98.4%], and 90.7% [85.5%, 94.3%]. There is significant heterogeneity in clinical, physiologic, and angiographic data in the currently available data on MAT. RCTs with consistent parameters and outcomes measures are still needed.