Balloon Guide Catheter is Not Superior to Conventional Guide Catheter when Stent Retriever and Contact Aspiration are Combined for Stroke Treatment

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S77-S77
Author(s):  
Romain Bourcier ◽  
Gaultier Marnat ◽  
Julien Labreuche ◽  
Hubert Desal ◽  
Federico Di Maria ◽  
...  
Keyword(s):  
Stent Retriever ◽  
Stroke Treatment ◽  
Guide Catheter

Balloon Guide Catheter is Not Superior to Conventional Guide Catheter when Stent Retriever and Contact Aspiration are Combined for Stroke Treatment

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. E83-E90
Author(s):  
Romain Bourcier ◽  
Gaultier Marnat ◽  
Julien Labreuche ◽  
Hubert Desal ◽  
Federico Di Maria ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Stent Retriever ◽  
Added Value ◽  
Complete Revascularization ◽  
First Line ◽  
Stroke Treatment ◽  
Guide Catheter ◽  
Significant Difference

Abstract BACKGROUND The effectiveness of balloon guide catheter (BGC) use has not been prospectively studied and its added value for improving reperfusion in acute ischemic stroke (AIS) treatment has only been reported in studies in which no contact aspiration was combined with the stent retriever (CA + SR). OBJECTIVE To compare the reperfusion results and clinical outcomes with and without BGC use when a combined CA + SR strategy is employed in first line to treat AIS. METHODS From January 2016 to April 2019, data from the ETIS registry (Endovascular Treatment in Ischemic Stroke) were reviewed. We included patients having undergone endovascular treatment with a combined CA + SR strategy and use or not of a BGC according to the operator's discretion. We compared BGC and nonBGC populations with matching and inverse probability of treatment weighting propensity scores. Primary outcome was the final near-complete/complete revascularization (mTICI2c/3) rate. Secondary outcomes included clinical outcomes and safety considerations. RESULTS Among 607 included patients, BGC was used in 32.9% (n = 200), and 190 matched pairs could be found. We found no significant difference in final mTICI2c/3 between patients with and without BGC (60.1% in BGC group compared to 62.7% in nonBGC group (matched RR, 0.92; 95%CI, 0.80 to 1.14)), first-pass mTICI2c/3 (35.1% vs 37.3%, matched RR, 0.94; 95%CI, 0.68 to 1.30), clinical outcome (matched RR of 1.12 (95%CI, 0.85 to 1.47) for favorable outcome. CONCLUSION The reperfusion and clinical results with and without BGC use are not significantly different when combined CA + SR are used as a first-line strategy for large vessel occlusion in the setting of AIS.

EXPRESS: Stent Retriever Alone vs. Aspiration and Stent-Retriever Combination in Large Vessel Occlusion Stroke: A Matched Analysis

2021 ◽  
pp. 174749302110192
Author(s):  
Mahmoud H Mohammaden ◽  
Diogo C. Haussen ◽  
Leonardo Pisani ◽  
Alhamza Al-Bayati ◽  
Aaron Anderson ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Functional Independence ◽  
Stent Retriever ◽  
Sensitivity Analyses ◽  
First Line ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Guide Catheter ◽  
First Pass ◽  
Combined Technique

Background Three randomized clinical trials have reported similar safety and efficacy for contact aspiration (CA) and Stent-retriever (SR) thrombectomy. Aim We aimed to determine whether the Combined Technique (SR+CA) was superior to SR alone as first-line thrombectomy strategy in a patient cohort where balloon-guide catheter was universally used. Methods A prospectively maintained mechanical thrombectomy database from January 2018-December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent SR alone thrombectomy or SR+CA as first-line therapy. The primary outcome was the first-pass effect (FPE) (mTICI2c-3). Secondary outcomes included modified FPE (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS ≤2). Safety outcomes included rate of parenchymal hematoma (PH) type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. Results A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16[11-21]). As compared to first-line SR alone, first-line SR+CA resulted in similar rates of FPE (53% vs. 51%,aOR 1.122, 95%CI[0.745-1.691],p=0.58), mFPE (63% vs. 60.4%,aOR1.250, 95%CI[0.782-2.00],p=0.35), final successful reperfusion (97.6% vs. 98%,p=0.75) and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%,aOR 2.033, 95%CI[1.209-3.419],p=0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line SR+CA treatment (81.8% vs. 73.6%,aOR 1.881, 95%CI[1.039-3.405],p=0.037). Conclusions Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a Combined Technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, addition of contact aspiration after initial SR failure might be beneficial in achieving earlier reperfusion.

Abstract WP18: Cerebral Mechanical Thrombectomy Simulator Using Hydrogel Polymers and 3D Printing Technology

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Timothy Campbell ◽  
Jonathan Stone ◽  
Arun Parmar ◽  
Edward Vates ◽  
Amrendra Miranpuri
Keyword(s):  
3D Printing ◽  
Mechanical Thrombectomy ◽  
Low Cost ◽  
Cerebral Arteries ◽  
Critical Time ◽  
Training Experience ◽  
Printing Technology ◽  
Stroke Treatment ◽  
3D Printing Technology ◽  
Guide Catheter

Introduction: While stroke remains a leading cause of death and disability, recent advances in endovascular technology an important opportunity to make a significant impact in clinical outcomes. However, training opportunities are rare, preventing dissemination of these techniques. Hands-on training is further complicated by the critical time to therapy associated with stroke treatment. This physical simulator was built for neurosurgical residents and fellows to practice mechanical thrombectomy. Methods: A simplified virtual model of the anterior cerebral circulation was created based on patient imaging. This luminal model was 3D printed using flexible filament and attached to a guide catheter at the proximal carotid to provide endovascular access and an IV tube at the distal M2 branches to permit outflow. A 7Fr sheath was also connected at the anterior cerebral artery to permit placement of a simulated clot model and simulate a proximal M1 occlusion. This entire construct was placed into a container of polyvinyl alcohol (PVA) and after crosslinking the flexible print was removed. Results: Using 3D printing technology and polymer hydrogels, a low-cost, high fidelity stroke model was achieved. Despite its simplified anatomy, the model permitted realistic wire and catheter navigation through the different segments of the internal carotid and middle cerebral arteries. The ACOM sheath provided a convenient method to reliably place an embolism and created a life-like proximal M1 occlusion. Recanalization was performed using the solumbra technique, which is used in live-patient cases. Conclusions: This model demonstrated proof of concept for a mechanical thrombectomy simulation. The angiographic profile and response to endovascular tools created a training experience similar to live endovascular procedures. As the model is perfected visually and mechanically, next steps are to perform validation studies and create a training curriculum.

Hyperdense vessel sign as a potential guide for the choice of stent retriever versus contact aspiration as first-line thrombectomy strategy

2020 ◽  
pp. neurintsurg-2020-016005 ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Diogo C Haussen ◽  
Catarina Perry da Camara ◽  
Leonardo Pisani ◽  
Marta Olive Gadea ◽  
...  
Keyword(s):  
Stent Retriever ◽  
Imaging Biomarker ◽  
First Line ◽  
Primary Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
First Line Therapy ◽  
Guide Catheter ◽  
First Pass ◽  
Secondary Analyses

BackgroundThe first-pass effect (FPE) has emerged as a key metric for efficacy in mechanical thrombectomy (MT). The hyperdense vessel sign (HDVS) on non-contrast head CT (NCCT) indicates a higher clot content of red blood cells.ObjectiveTo assess whether the HDVS could serve as an imaging biomarker for guiding first-line device selection in MT.MethodsA prospective MT database was reviewed for consecutive patients with anterior circulation large vessel occlusion stroke who underwent thrombectomy with stent retriever (SR) or contact aspiration (CA) as first-line therapy between January 2012 and November 2018. Pretreatment NCCT scans were evaluated for the presence of HDVS. The primary outcome was FPE (modified Thrombolysis in Cerebral Infarction score 2c/3). The primary analysis was the interaction between HDVS and thrombectomy modality on FPE. Secondary analyses aimed to evaluate the predictors of FPE.ResultsA total of 779 patients qualified for the analysis. HDVS and FPE were reported in 473 (60.7%) and 286 (36.7%) patients, respectively. The presence of HDVS significantly modified the effect of thrombectomy modality on FPE (p=0.01), with patients with HDVS having a significantly higher rate of FPE with a SR (41.3% vs 22.2%, p=0.001; adjusted OR 2.11 (95% CI 1.20 to 3.70), p=0.009) and non-HDVS patients having a numerically better response to CA (41.4% vs 33.9%, p=0.28; adjusted OR 0.58 (95% CI 0.311 to 1.084), p=0.088). Age (OR 1.01 (95% CI 1.00 to 1.02), p=0.04) and balloon guide catheter (OR 2.08 (95% CI 1.24 to 3.47), p=0.005) were independent predictors of FPE in the overall population.ConclusionOur data suggest that patients with HDVS may have a better response to SRs than CA for the FPE. Larger confirmatory prospective studies are warranted.

PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy – evaluation of a double embolic protection approach in endovascular stroke treatment

2017 ◽  
Vol 10 (8) ◽  
pp. 751-755 ◽  
Author(s):  
Christian Maegerlein ◽  
Sebastian Mönch ◽  
Tobias Boeckh-Behrens ◽  
Manuel Lehm ◽  
Dennis M Hedderich ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Balloon Occlusion ◽  
Stent Retriever ◽  
Thrombus Aspiration ◽  
Technical Approach ◽  
Distal Embolization ◽  
New Approach ◽  
Stroke Treatment ◽  
Embolic Protection ◽  
Control Study

PurposeStent retriever-based mechanical thrombectomy (MT) for emergent large vessel occlusions (ELVO) is often complicated by thrombus fragmentation causing distal embolization and embolization to new vascular territories. Well-established embolic protection approaches include proximal flow arrest and distal aspiration techniques during stent retriever maneuvers. Aiming at the reduction of thrombus fragmentation during MT we evaluated a technical approach combining proximal balloon occlusion together with direct thrombus aspiration during MT: the PROTECT technique.MethodsWe performed a case-control study comparing the PROTECT technique with sole distal aspiration during MT regarding technical and procedural parameters, n=200 patients with ELVO of either the terminus of the internal carotid artery or the proximal middle artery were included.ResultsPROTECT resulted in a shorter procedure time (29 vs 40 min; P=0.002), in a higher rate of successful recanalizations (100% vs 78%; P=0.001) and a higher rate of complete reperfusions (70% vs 39%; P<0.001) compared with sole distal aspiration during MT.ConclusionThe PROTECT technique is a promising new approach to significantly reduce thrombus fragmentation and, hence distal embolization during MT. This safe and efficient technique needs to be validated in larger trials to confirm our results.

scholarly journals ADVANCE: An effective and feasible technique in acute stroke treatment

2016 ◽  
Vol 23 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Erdem Gurkas ◽  
Cetin Kursad Akpinar ◽  
Emrah Aytac
Keyword(s):  
Functional Outcome ◽  
Standard Technique ◽  
Stent Retriever ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Good Functional Outcome ◽  
Large Patient ◽  
Patient Series ◽  
Initial Results ◽  
Better Than

Background and purpose Different techniques regarding efficient utilization of thrombectomy devices have been reported. Here, we described a novel technique named ADVANCE that is based on advancing a distal access catheter over the stent retriever. In this study, we aimed to report our initial results with this novel thrombectomy technique. Methods and results Sixty-seven consecutive acute anterior circulation ischemic stroke patients (35 male, 32 female) between January 2015 and January 2016 who were treated by mechanical thrombectomy were included in this prospective study. Patients were classified randomly into two groups: patients treated with either the ADVANCE technique or standard technique. Patients had a mean age of 61.1 ± 12.9 years. The average NIHSS score was 15.8 ± 3.8. In the ADVANCE group, the successful revascularization (mTICI 2b–3) rate was 87.1% and the 90-day good functional outcome rate (mRS 0–2) was 74.1%. The revascularization rate in the ADVANCE group was significantly ( p = 0.005) better than the standard technique group and good functional outcome at 90 days in the ADVANCE group was non-significantly better than the standard technique group ( p = 0.052). Conclusions ADVANCE is the first comparison of this technique to standard stent retriever thrombectomy with a higher rate of revascularization with no emboli to new territory and fewer distal emboli to target territory. This safe and efficient technique needs to be validated in large patient series in new thrombectomy trials.

Expanding the role of stent-retriever endovascular thrombectomy: a case series of free-floating thrombus

2018 ◽  
Vol 10 (12) ◽  
pp. 1164-1167 ◽  
Author(s):  
Neasa Fitzpatrick ◽  
Ronan Motyer ◽  
Brian Gibney ◽  
Sharon Duffy ◽  
Sean Murphy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Management Strategies ◽  
Case Series ◽  
Stent Retriever ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Floating Thrombus ◽  
Endovascular Interventions ◽  
Clinically Significant ◽  
Best Medical Therapy

Carotid artery free-floating thrombus (FFT) is a rare but clinically significant cause of embolic stroke. Treatment has historically been confined to carotid surgery or best medical therapy, with neither option proved to be superior. However, recent advancements in endovascular interventions have heralded a new age of innovative management strategies for vascular disease. We present three distinct cases of stroke secondary to carotid artery FFT, successfully treated with stent retriever endovascular thrombectomy.

Preclinical evaluation of the ANCD thrombectomy device: safety and efficacy in a swine clot model

2020 ◽  
Vol 12 (10) ◽  
pp. 1008-1013 ◽  
Author(s):  
Sonia Sanchez ◽  
Lynn Bailey ◽  
Rebecca Ducore ◽  
Tommy Andersson ◽  
Raul Nogueira ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Stent Retriever ◽  
Histopathological Analysis ◽  
Efficacy And Safety ◽  
Guide Catheter ◽  
Vessel Injury ◽  
First Pass ◽  
Thrombectomy Device ◽  
Clinically Significant ◽  
Model Support

BackgroundThe Advanced Thrombectomy System (ANCD) provides a new funnel component designed to reduce clot fragmentation and facilitate retrieval in patients with stroke by locally restricting flow, allowing distal aspiration in combination with a stent retriever (SR).ObjectiveTo evaluate the preclinical efficacy and safety of the ANCD in a swine clot model.MethodsSoft and firm clots were implanted in the lingual and cervical arteries of 11 swine to obtain Thrombolysis in Cerebral Infarction (TICI) 0 blood flow. Mechanical thrombectomy was performed with either a balloon guide catheter+Solitaire 2 stent retriever (BGC+SR, n=13) or ANCD+SR (n=13). TICI flow was evaluated and successful revascularization was defined as TICI 3 (normal perfusion). To characterize safety, a total of 3 passes were performed in each vessel independent of recanalization. Tissues were explanted for histopathological analysis after 3 and 30 days, respectively.ResultsFirst pass reperfusion rates were ANCD+SR: 69% and BGC+SR: 46%. Reperfusion increased after the third pass in both groups (ANCD+SR: 100%, vs BGC+SR: 77%). Recanalization was achieved after an average of 1.4 and 1.9 passes in ANCD+SR and BGC+SR (p=0.095), respectively. Vessel injury was comparable in both groups; endothelial loss at 3 days was the most common injury seen (ANCD+SR: 1.78±1.22; BGC+SR: 2.03±1.20; p=0.73), while other histopathological markers were absent or minimal. Tissues downstream from targeted vessels also showed absence or minimal lesions across both groups.ConclusionsResults in a swine clot model support the high efficacy of the ANCD+SR without causing clinically significant vessel injury potentially related to the new funnel component.

Abstract WP26: Use of Balloon-guide Catheter Bridges the Difference in Technical Outcomes Between Adapt and Stent Retriever Thrombectomy for Ischemic Stroke - Insights From STAR Collaboration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ali M Alawieh ◽  
Reda Chalhoub ◽  
Mohammad Anadani ◽  
Maya Eid ◽  
Eyad Almallouhi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Independent Predictor ◽  
Star Collaboration ◽  
Lower Number ◽  
Stent Retriever ◽  
Procedure Time ◽  
Aspiration Thrombectomy ◽  
Guide Catheter ◽  
Significant Difference ◽  
The Difference

Introduction: Recently completed randomized controlled trials comparing aspiration thrombectomy (ADAPT) to stent retriever thrombectomy (SRT) demonstrated similar clinical outcomes, but faster thrombectomy procedure time in the ADAPT group. This study evaluates the difference in technical outcomes between ADAPT and SRT combined with balloon-guide catheters (BGC). Methods: Patients undergoing thrombectomy for acute ischemic stroke at 12 comprehensive stroke centers in the US and Europe between 01/2013 and 12/2018 were reviewed. Data was collected retrospectively from patient charts, procedure notes, and patient follow-up in neurology clinics. Clinical endpoint was the modified Rankin score (mRS) at 90-days, and technical outcomes were procedure time, total attempts, and mTICI scores. Results: The study included 2,016 patients (mean age 69±15) who underwent stroke thrombectomy using ADAPT (46%), SRT (46%), or SRT+BGC (8%). Similar baseline characteristics were observed between the three groups, and no significant difference in mRS scores at 90-days between the three groups in univariate and multivariate analyses. Thrombectomy performed using SRT+BGC required significantly shorter procedure time compared to SRT (35 vs 61 min, p<0.001) that was comparable to ADAPT (36 min, p>0.1). However, use of SRT+BGC required significantly lower number of aspiration attempts compared to ADAPT (median 1 vs. 2, p<0.05). On multivariate linear regression, use of SRT+BGC independent predicted a significant reduction in procedure time compared to SRT (coefficient=-30.6, p<0.001), and significantly lower number of attempts compared to ADAPT (coefficient=-0.4, p=0.01). SRT+BGC was an independent predictor of higher mortality compared to ADAPT (OR=2.4, p<0.01), despite comparable rates of favorable outcomes (mRS 0-2) between the two groups. Use of SRT+BGC was not an independent predictor of symptomatic hemorrhage or complications compared to SRT or ADAPT. Conclusions: This study shows that although ADAPT allows for faster procedure time compared to SRT, the use of BGC in SRT allows for a comparable procedure time to ADAPT with similar overall rates of favorable outcome, complications and hemorrhage. Mortality was higher with the use of BGC compared to ADAPT.

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