Abstract 1122‐000101: First‐in‐Human Experience Using the Millipede 088 Aspiration Catheter in Stroke Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
John Thornton Thornton ◽  
Matthew Crockett ◽  
Pervinder Bhogal ◽  
Levansri Makalanda ◽  
Raul G Nogueira
Keyword(s):  
Additional Treatment ◽  
Target Vessel ◽  
Aspiration Thrombectomy ◽  
Physician Performance ◽  
Radiological Data ◽  
First Pass ◽  
Catheter Size ◽  
Clot Aspiration ◽  
Tandem Lesions ◽  
Distal Flow

Introduction : Studies have suggested that closely matching the catheter size to the vessel size may improve the effectiveness of clot aspiration in stroke thrombectomy. A new category of “super‐bore” aspiration catheters with 8Fr OD and 0.088in ID has recently been developed to further improve reperfusion success. In this work we report on early clinical experience using a CE Marked device called Millipede 088 developed by Perfuze (Galway, Ireland). Methods : The clinical, procedural, and radiological data were reviewed for consecutive cases in which Millipede 088 was used. Millipede 088 was navigated to the target vessel over a 6F intermediate catheter with or without a microcatheter and microwire, at the discretion of the physician. Performance was evaluated in terms of successful intracranial navigation and reperfusion measured using the mTICI scale. Results : Ten patients (age 55–89 years, 50% male) with intracranial large vessel occlusions (LVOs) were treated ‐ 4 ICA and 6 M1 LVOs. In two cases, the patients had concomitant tandem lesions requiring additional treatment. Millipede 088 was delivered intracranially in all cases, and to the target vessel in 8 cases. In two cases in which Millipede 088 was not advanced to the target vessel, it was placed intracranially for distal flow control, and an intermediate catheter was used for clot aspiration. In one case, following mTICI 2b reperfusion after aspiration, a stentriever was deployed via Millipede 088 to retrieve a distal M2 clot. Excellent reperfusion (mTICI 2c‐3) at the end of the procedure, was achieved in all (100%) of patients. First‐pass mTICI 2c‐3 was achieved in 5 patients (50%). No sICH or other complications were reported. Conclusions : In this first in man experience, aspiration thrombectomy using the Millipede 088 proved to be technically feasible and safe. Excellent reperfusion was achieved in all patients. The Millipede 088 represents a promising option for stroke thrombectomy.

Abstract P33: Blind Exchange With the Mini-Pinning Technique Using Tron Fx Retriever for M2 Occlusion Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Takeshi Yoshimoto
Keyword(s):  
Stent Retriever ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Target Vessel ◽  
Stroke Patients ◽  
Technical Improvement ◽  
Vessel Size ◽  
Blind Navigation ◽  
First Pass ◽  
Stent Retrievers

Introduction: Technical improvement to enhance M2 occlusion thrombectomy is desirable. Tron FX® is the only stent-retriever that can be deployed through 0.0165-inch microcatheters. Here we report outcomes of blind exchange with mini-pinning (BEMP) technique using Tron stent-retrievers. Methods: Consecutive stroke patients with M2 occlusion treated with 2 x15 mm or 4 x 20 mm Tron stent-retrievers using the BEMP technique were included. The technique involves the deployment of a Tron stent-retriever through a 0.0165-inch microcatheter followed by microcatheter removal and blind navigation of a 3/4MAX aspiration catheter over the bare Tron delivery wire until the aspiration catheter reaches the clot,. Tron stent-retriever was inserted into aspiration catheter like corkscrew, and subsequently pulled as a unit. A first pass effect (FPE), modified FPE (mFPE) and modified Rankin Scale (mRS) score at 90 days were assessed as outcomes. Results: Fifteen M2 vessels were treated in 13 patients (5 women, median 81 years of age, and median National Institutes of Health Stroke Scale score 18 [11–25]). BEMP technique was successful in all cases. Whether to use 3MAX or 4MAX was determined according to the target vessel size while proceeding with the procedure (3MAX, n=8; 4MAX, n=5). Final mTICI 2b–3 was achieved in 92% (12/13). FPE and mFPE rates were 50% and 64%, respectively. Six patients (46%) were achieved in mRS score 0–2 at 3 months. Conclusions: Tron stent-retriever was successfully and safely used in the BEMP technique for M2 occlusion

scholarly journals Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jin Wook Choi ◽  
Miran Han ◽  
Jung Hyun Park ◽  
Woo Sang Jung
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Treatment Method ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Procedure Time ◽  
First Line ◽  
Aspiration Thrombectomy ◽  
First Pass ◽  
First Line Treatment

Abstract Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.

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

2020 ◽  
pp. neurintsurg-2020-016547
Author(s):  
Vance L Fredrickson ◽  
Phillip A Bonney ◽  
Shivani D Rangwala ◽  
Joshua S Catapano ◽  
Tyler S Cole ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Multivariable Analysis ◽  
Large Vessel ◽  
Aspiration Thrombectomy ◽  
Patient Demographics ◽  
Radiographic Outcomes ◽  
Operator Series ◽  
First Pass

BackgroundBoth stentriever and direct-aspiration thrombectomy effectively treat large-vessel occlusions. However, data are limited comparing clinical outcomes after aspiration-first versus stentriever-assisted aspiration for thrombectomy.MethodsA retrospective cohort study compared procedure times and radiographic outcomes after two mechanical thrombectomy techniques (aspiration first or stentriever). To minimize bias and variability inherent to multi-operator series, we assessed consecutive patients with cerebrovascular occlusions treated by a single surgeon during a 1 year period at two stroke centers. Expanded Thrombolysis in Cerebral Infarction (eTICI) grades were assessed by an investigator blinded to treatment.ResultsData from 93 patients (median age 70 years) were analyzed: 73 patients (78.5%) were treated with a strentriever-first strategy and 20 (21.5%) were treated with aspiration first, with stentriever rescue therapy required in only three of these cases following unsuccessful aspiration. There were no significant differences in patient demographics, sites of occlusion, or rates of tandem occlusions between aspiration-first and stentriever-assisted groups (p≥0.36). The rate of first-pass eTICI ≥2b was 75.0% (15/20) for aspiration-first and 52.1% (38/73) for strentriever-first groups (p=0.07), while the rate of final eTICI ≥2b was 100% (20/20) and 82.2% (60/72), respectively (p=0.04). The aspiration-first technique was associated with procedural times ≤25 min in a multivariable analysis (adjusted OR 4.77, 95% CI 1.15 to 18.39; p=0.03).ConclusionsIn this single-surgeon series, an aspiration-first technique was associated with a statistically significant improvement in eTICI outcomes and faster procedure times compared with stentriever-assisted aspiration. Further prospective studies are necessary to minimize selection bias inherent in this study design.

Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy

2019 ◽  
Vol 11 (10) ◽  
pp. 979-983 ◽  
Author(s):  
Dong-Hun Kang ◽  
Jin Woo Kim ◽  
Byung Moon Kim ◽  
Ji Hoe Heo ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Stent Retriever ◽  
First Line ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Endovascular Thrombectomy ◽  
Negatively Associated ◽  
Good Outcome ◽  
Rescue Treatment ◽  
First Pass

BackgroudThe need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT.MethodsWe identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome.ResultsA total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870).ConclusionCA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.

Aspiration thrombectomy using a novel 088 catheter and specialized delivery catheter

2021 ◽  
pp. neurintsurg-2021-018318
Author(s):  
James Caldwell ◽  
Ben McGuinness ◽  
Shane S Lee ◽  
P Alan Barber ◽  
Andrew Holden ◽  
...  
Keyword(s):  
Phase 1 ◽  
Phase 2 ◽  
Phase 3 ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Aspiration System ◽  
First Pass ◽  
Reperfusion Rate ◽  
Delivery Catheter ◽  
Three Phases

BackgroundWe describe the first-in-human experience using the Route 92 Medical Aspiration System to perform thrombectomy in the initial 45 consecutive stroke patients enrolled in the SUMMIT NZ trial. This aspiration system includes a specifically designed delivery catheter which enables delivery of 0.070 inch and 0.088 inch aspiration catheters.MethodsThe SUMMIT NZ trial is a prospective, multicenter, single-arm study with core lab imaging adjudication. Patients presenting with acute ischemic stroke from large vessel occlusion are eligible to enrol. The study has had three phases which transitioned from use of the 0.070 inch to the 0.088 inch catheter.ResultsVessel occlusions were located in the internal carotid artery (27%), M1 (60%) and M2 (13%). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16 (IQR 10). Across the three phases, the first-pass reperfusion rate of modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b was 62% using the Route 92 Medical system; this rate was 29% in phase 1, 56% in phase 2, and 80% in phase 3. The first-pass reperfusion rate of mTICI ≥2c was 42% overall, 29% in phase 1, 33% in phase 2%, and 55% in phase 3. A final reperfusion rate of mTICI ≥2b was achieved in 96% of cases, with 36% of cases using adjunctive devices. Patients had an average improvement of 6.7 points in NIHSS from baseline at 24 hours, and at 90 days 48% were functionally independent (modified Rankin Scale 0–2).ConclusionsIn this early experience, the Route 92 Medical Aspiration System has been effective and safe. The system has design features that improve catheter deliverability and have the potential to increase first-pass reperfusion rates in aspiration thrombectomy.

MRS SOFIA: a multicenter retrospective study for use of Sofia for revascularization of acute ischemic stroke

2021 ◽  
pp. neurintsurg-2020-017042
Author(s):  
Waleed Brinjikji ◽  
Eytan Raz ◽  
Reade De Leacy ◽  
Dan Meila ◽  
Maxim Mokin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Retrospective Study ◽  
Acute Ischemic Stroke ◽  
Median Number ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
First Pass ◽  
Number Of Passes

BackgroundOver the past several years there has been increased interest in the use of the Sofia aspiration system (MicroVention, Tustin, California) as a primary aspiration catheter.ObjectiveTo perform a multicenter retrospective study examining the efficacy of the Sofia aspiration catheter as a standalone aspiration treatment for large vessel occlusion.MethodsConsecutive cases in which the Sofia catheter was used for aspiration thrombectomy for large vessel occlusion were included. Exclusion criteria were the following: (1) Sofia not used for first pass, and (2) a stent retriever used as an adjunct on the first pass. The primary outcome of the study was first pass recanalization (Thrombolysis in Cerebral Infarction (TICI) 2c/3). Secondary outcomes included first pass TICI 2b/3, crossover to other thrombectomy devices, number of passes, time from puncture to recanalization, and complications.Results323 patients were included. First pass TICI 2c/3 was achieved in 49.8% of cases (161/323). First pass TICI 2b/3 was achieved in 69.7% (225/323) of cases. 74.8% had TICI 2b/3 with the Sofia alone. Crossover to other thrombectomy devices occurred in 29.1% of cases (94/323). The median number of passes was 1 (IQR=1–3). Median time from puncture to recanalization was 26 min (IQR=17–45). Procedure related complications occurred in 3.1% (10/323) of cases.ConclusionOur study highlights the potential advantage of the Sofia aspiration catheter for primary aspiration thrombectomy in acute ischemic stroke. High rates of first pass recanalization with low crossover rates to other thrombectomy devices were achieved. Median procedure time was low, as were procedural complications.

Abstract WP15: Rates of Successful First-pass Recanalization During Thrombectomy for Acute Ischemic Stroke are Higher in the Absence of a Hyper-dense Vessel Sign

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Cynthia L Kenmuir ◽  
Alhamza R Al-Bayati ◽  
Hazem Shoirah ◽  
Amin Aghaebrahim ◽  
Andrew F Ducruet ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
High Quality ◽  
Aspiration Thrombectomy ◽  
Endovascular Thrombectomy ◽  
First Pass ◽  
Multimodal Methods ◽  
Ratio Versus

Background and Purpose: Rates of high quality recanalization after endovascular thrombectomy in acute ischemic stroke are excellent, but not all vessels are easily or quickly recanalized. Physical characteristics of the occlusion may affect recanalization. The hyper-dense vessel sign (HDVS) is an easily obtained marker of clot density and was hypothesized to predict success of recanalization. Methods: A prospectively maintained database of patients undergoing mechanical thrombectomy was retrospectively analyzed. The final quality of recanalization was scored by the treating interventionalist. The presence or absence of HDVS was scored blinded. HDVS was defined as an absolute HU >43 and ratio versus contralateral vessel of >1.2 on non-contrast head CT. Results: 408 patients were treated with endovascular thrombectomy between August 2012 to July 2015. Mean age was 67.7. 53% were men. Mean NIHSS was 17. 88% were MCA occlusions and 11% were basilar occlusions. Mean ASPECT was 8.6 for MCA occlusions. 90.6% of patients were successfully revascularized with TICI2b/3. HDVS was identified in 43.3% of patients. 40.5% of patients had TICI2b/3 reperfusion after the first pass of attempted thrombectomy. Manual aspiration thrombectomy was the first technique in 45.6% and stentreiver mediated manual aspiration thrombectomy was used first in 54.4% of cases. Of 357 attempted MCA thrombectomies, 43.3% had a HDVS. Of 44 attempted basilar thrombectomies, 56.7% had a HDVS. TICI 2b/3 reperfusion on first-pass was associated with absence of HDVS (p=0.001). Time from puncture to reperfusion was significantly increased with HDVS (p=0.003). Conclusion: Patients with a hyper-dense vessel sign have less successful first-pass revascularization with increased times to reperfusion versus patients without a hyper-dense vessel sign. The presence of HDVS may be indicative of more refractory occlusions and may warrant novel and multimodal methods of revascularization.

scholarly journals Seeing Is Believing: Headway27 as a Highly Visible and Versatile Microcatheter with Ideal Dimensions for Stroke Thrombectomy

2018 ◽  
Vol 7 (6) ◽  
pp. 341-346 ◽  
Author(s):  
William J. Ares ◽  
Benjamin M. Zussman ◽  
Cynthia L. Kenmuir ◽  
Gregory M. Weiner ◽  
Habibullah Ziayee ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Basilar Artery ◽  
Posterior Circulation ◽  
Target Vessel ◽  
Aspiration Thrombectomy ◽  
Intended Target ◽  
Patient Demographics ◽  
Procedural Complications ◽  
Technical Details ◽  
Technique Evaluation

Introduction: Microcatheter selection is an infrequent focus of stroke thrombectomy technique evaluation. The Headway27 microcatheter strikes an excellent balance of microcatheter dimensions (156 cm length, 2.6 Fr distal OD, ID 0.027 inches) and visibility, making it ideal for stroke thrombectomy. Methods: We evaluated a prospectively maintained acute stroke thrombectomy database containing 50 consecutive cases using the Headway27 microcatheter. From the database, patient demographics, clinical and angiographic information as well as procedural technical details and complications were extracted. Results: Manual aspiration thrombectomy (MAT) was performed alone in 72% of cases, stentriever-assisted MAT was performed in 6% of cases, and a combination was used in 22% of cases. Median groin puncture to final recanalization time was 27 min and mTICI 2B/3 recanalization was achieved in 94% of cases. There were 2 intra-procedural complications, neither related to the microcatheter. In all cases, the Headway27 reached the intended target vessel: M1 (n = 4), M2 (n = 26), M3 (n = 13), P2 (n = 3), P3 (n = 1), and basilar artery (n = 3). There were no cases requiring usage of an additional or alternative microcatheter. In 45/47 cases of MAT, the reperfusion catheter tracked over the Headway to the clot/intended target; in two cases, the microcatheter was used to deploy a stentriever that then allowed the reperfusion catheter to track to the clot. Conclusion: The Headway27 microcatheter reliably facilitated rapid clot access in anterior and posterior circulation acute large vessel occlusions with no microcatheter-associated complications.

Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy

2019 ◽  
Vol 11 (7) ◽  
pp. 637-640 ◽  
Author(s):  
Daniel A Tonetti ◽  
Shashvat M Desai ◽  
Stephanie Casillo ◽  
Benjamin M Zussman ◽  
Merritt W Brown ◽  
...  
Keyword(s):  
Randomized Trials ◽  
Internal Carotid ◽  
Independent Predictor ◽  
Procedure Time ◽  
Multivariate Logistic Regression ◽  
Aspiration Thrombectomy ◽  
First Pass ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Number Of Passes

IntroductionVarious large-bore catheters can be employed for manual aspiration thrombectomy (MAT); clinical differences are rarely explored.MethodsProspectively collected demographic, angiographic, and clinical data for patients with acute internal carotid artery, middle cerebral artery M1, or basilar occlusions undergoing MAT over 23 months at a comprehensive stroke center were reviewed. We excluded patients in stentriever-based randomized trials/registries. The four most commonly utilized aspiration catheters were analyzed, and multivariate logistic regression analyses were performed to determine the effect of primary aspiration catheter choice on first-pass success, final reperfusion, and modified Rankin Scale (mRS) score at 90 days.ResultsOf 464 large vessel thrombectomies, 180 were performed via MAT on the first pass with one of four catheters. First-pass success was achieved in 42% of cases overall; this rate did not differ significantly between catheters: 50% for Sofia, 45% for CAT6, 40% for 0.072 inch Navien, and 36% for ACE68, p=0.67. Final Thrombolysis in Cerebral Infarction 2b or 3 reperfusion was achieved in 94% of cases overall: 97% of cases with CAT6, 95% with Sofia, 92% with Navien, and 92% with ACE68, p=0.70. Mean number of passes for index thrombus (2.0 overall), median procedure time (32 min overall), 90-day good outcome (mRS 0–2, mean 36%), and 90-day mortality (mean 27%) did not differ significantly between patients treated with different initial catheters.ConclusionAmong large-bore aspiration catheters, catheter selection is not an independent predictor of first-pass success, final reperfusion, or clinical outcome.

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