scholarly journals The Q and A—The MIVI Q Catheters for Aspiration Thrombectomy—Initial Experience from London

2021 ◽  
Vol 10 (24) ◽  
pp. 5844
Author(s):  
Levansri Makalanda ◽  
Joseph Lansley ◽  
Ken Wong ◽  
Oliver Spooner ◽  
Pervinder Bhogal
Keyword(s):  
Initial Experience ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Aspiration System ◽  
Novel Technology ◽  
Early Results ◽  
Procedural Time ◽  
Stent Retrievers ◽  
Tandem Lesions ◽  
Number Of Passes

Background: Aspiration thrombectomy is a widely accepted treatment option for large vessel occlusion (LVO). The MIVI aspiration system has a novel design to maximize the lumen size. We present the results of our initial experience with this innovative aspiration thrombectomy system. Materials and Methods: Retrospectively, we reviewed our database to find all cases of LVO treated with the MIVI Q system (February 2019 and July 2020). In addition, we recorded the baseline demographics, NIHSS, ASPECT, mTICI scores, procedural time, complications, and 90 day mRS. Results: Herein, we identified 25 patients with an average age of 65.3 ± 19.3 years (range 19–89), majority of whom were female (n = 14, 56%). The average NIHSS was 16.9 ± 6.7 (range 6–30), and the average CT ASPECT was 7.9 ± 1.4 (range 5–10). The most common clot location was the M1 segment of the MCA (n = 16, 64%). Four of the patients had tandem lesions (16%). The average clot length was 21.7 ± 31 mm (range 2–130 mm). Of the 23 cases where the Q catheter reached the proximal clot face, mTICI ≥ 2b was achieved on the first pass in 11 cases (44%), and at the end of the ‘Q aspiration’ only the procedures with 16 patients achieved mTICI ≥ 2b recanalization (64%). Stent-retrievers were used in 13 cases (52%). At the end of the procedure, 24 patients (96%) achieved mTICI ≥ 2b with 18 patients (72%) achieving mTICI ≥ 2c. The average number of passes with the Q catheter, including when it was used for SOLUMBRA, was 2.1 ± 2.2 (range 1–10). The mean procedure time was 69 ± 32 mins (range 7–116 mins). No complications were associated with the MIVI Q. Conclusions: The MIVI aspiration system is a novel technology with regards to aspiration mechanical thrombectomy. The system is easy to use with early results comparable to other large-bore catheter systems. However, further studies are needed.

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.

scholarly journals Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use

2018 ◽  
Vol 7 (6) ◽  
pp. 327-333 ◽  
Author(s):  
Mohamed S. Teleb
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Guide Catheter ◽  
Stent Retrievers ◽  
Number Of Passes ◽  
Single Center Observational Study

Background: Treatment of large vessel occlusion acute ischemic stroke with mechanical thrombectomy has become the standard of care after recent clinical trials. However, the degree of recanalization with stent retrievers remains very important in overall outcomes. We sought to review the utility of a new balloon guide catheter (BGC) in improving the degree of recanalization in conjunction with mechanical thrombectomy. Methods: The medical records of a prospectively collected endovascular ischemic stroke database were reviewed. All consecutive strokes when a FlowGate BGC was used with a thrombectomy stent retriever were identified. Use of a FlowGate BGC, number of passes, final Thrombolysis in Cerebral Infarction (TICI) score, trackability, and use of adjunct devices were all collected and analyzed. Results: Use of a FlowGate BGC resulted in 64% (33/52) first-pass effect (FPE) of TICI 2b/3, and specifically 46% (24/52) TICI 3 FPE (true FPE). A total of 52/62 (84%) of thrombectomy cases were treated with BGCs. In the remaining 10, the BGC was not inflated or used due to the clot not being visualized or the lesions being distal and BGC use thus not deemed appropriate. Adjunct use of an aspiration catheter was seen in 12% (6/52) of cases. The overall success with FlowGate BGCs with one or more passes of TICI 2b/3 was 94% (49/52). Trackability was achieved in 92% (57/62) of cases. Conclusions: Use of the FlowGate BGC as an adjunct to mechanical thrombectomy was associated with good FPE and an overall recanalization of TICI 2b/3 of 94%.

scholarly journals Number of passes in mechanical thrombectomy: where is your limit?

2020 ◽  
Vol 33 (3) ◽  
pp. 78-82
Author(s):  
A. Filioglo ◽  
J.E. Cohen ◽  
N. Simaan ◽  
A. Honig ◽  
R.R. Leker
Keyword(s):  
Mechanical Thrombectomy ◽  
Short Review ◽  
Functional Independence ◽  
Hemorrhagic Transformation ◽  
Published Data ◽  
Vessel Occlusion ◽  
Procedural Time ◽  
Time Required ◽  
The Impact ◽  
Number Of Passes

Background and aims. Stent retriever based thrombectomy is the mainstay of treatment of acute ischemic stroke caused by large vessel occlusion. However, recanalization is sometimes not achieved even after multiple passes of the thrombectomy device. Whether revascularization becomes futile or harmful with an increasing number of passes as well as criteria for when to halt attempting recanalization remain unknown. The purpose of our work is to analyze literature data on this issue. Materials and methods. We performed a short review of the literature and summarized evidence on the impact of repeated stentriever attempts on outcome.Results. Despite some controversies, the published data indicate that up to 30 % of patients still reach favorable outcome even when ≥5 stentriever passes are performed. Probability of obtaining functional independence after multiple stentriever attempts is even higher in patients with lower baseline NIHSS score. Patients who achieve successful reperfusion after ≥5 passes have significantly higher rates of functional independence and significantly lower rates of hemorrhagic transformation compared with those who do not achieve reperfusion. Rate of target recanalization after ≥4 passes may reach 19 %. Number of passes alone is not an independent negative predictor of functional independence. The impact of multiple stentriever attempts on hemorrhagic transformation has not been well-established.Conclusions. Target vessel recanalization is an essential goal of mechanical thrombectomy, which should be pursued despite the additional number of passes and procedural time required. Number of stentriver attempts is not a game- changing factor in the decision to abort the procedure for technical futility. Treatment decisions need to be individualized for each patient based on operator’s experience and preferences, patient and clot-specific characteristics.

Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters

2016 ◽  
Vol 9 (10) ◽  
pp. 944-947 ◽  
Author(s):  
Gaurav Jindal ◽  
Yafell Serulle ◽  
Timothy Miller ◽  
Elizabeth Le ◽  
Marcella Wozniak ◽  
...  
Keyword(s):  
Combination Group ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
New Device ◽  
Stent Retrieval ◽  
Concurrent Use ◽  
Procedural Time ◽  
Stent Retrievers ◽  
And Control ◽  
Mean Time

BackgroundNew device technology has changed the techniques used for revascularization of emergent large vessel occlusion in acute stroke. We report technical results using stent retrievers (SRs) for thrombectomy alone versus SRs used in conjunction with a new group of devices, intracranial aspiration catheters (IACs). Our aim is to demonstrate differences in procedural time and thrombectomy attempts between these two groups.MethodsA retrospective evaluation was performed of a prospectively maintained database of 97 patients treated at a single institution for anterior circulation stroke with SRs. Patients were divided into two groups, a combination group defined as the SR/IAC group and the SR alone group defined as the SR group.ResultsPatients in the SR/IAC group had a mean age of 66 years vs 59 years in the SR group (p=0.008). Mean presenting National Institutes of Health Stroke Scale (NIHSS) scores in the SR/IAC and control groups were 18.7 and 18.2, respectively (p=0.50). Recanalization rates (Thrombolysis In Cerebral Infarction (TICI) 2b or 3) in the SR/IAC and SR groups were 85% (58/68) and 90% (26/29), respectively (p=0.41). Mean time from groin arteriotomy to recanalization was 50±3.6 min (range 19–136) in the SR/IAC group (n=59) and 61±6.6 min (range 28–140) in the SR group (n=27) (p=0.049). The total number of thrombectomy attempts in the SR/IAC and SR groups were 1.9±0.1 (range 1–4) and 2.5±0.6 (range 1–6), respectively (p=0.009). Post-procedural subarachnoid hemorrhage was seen in 15% (10/68) and 10% (3/29) of cases in the SR/IAC and SR groups, respectively (p=0.41).ConclusionWhen using SRs for intracranial stroke thrombectomy, the concurrent use of IACs is associated with a decrease in procedural time and thrombectomy attempts compared with use of SRs alone.

scholarly journals Aspiration Thrombectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Raymond Turner ◽  
Aquilla Turk ◽  
Imran Chaudry ◽  
Jan Vargas ◽  
Adam Arthur ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Options ◽  
Video Recording ◽  
Large Vessel ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Ct Angiogram ◽  
Stent Retrievers ◽  
Noncontrast Computed Tomography

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

Abstract TP34: Endovascular Thrombectomy for M1 Vessel Occlusion: Comparison Between Stent Retriever Mediated Thrombectomy and Forced Aspiration Thrombectomy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michelle Nunes ◽  
Pedro Aguilar-Salinas ◽  
Thais Varzoni ◽  
John Entwistle ◽  
Eric Sauvageau ◽  
...  
Keyword(s):  
Statistical Significance ◽  
High Volume ◽  
Stent Retriever ◽  
Stroke Therapy ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Endovascular Thrombectomy ◽  
Improved Outcomes ◽  
Stent Retrievers ◽  
Single Modality

Introduction: An evolution in endovascular approaches has been observed in the last decade with stent retrievers (ST) being the latest generation of devices. Stent retriever thrombectomy and manual aspiration (MAT) have each shown to lead to high rates of recanalization as single modality endovascular stroke therapy. We aimed to compare clinical outcomes, efficacy and safety of ‘stent retriever mediated manual aspiration thrombectomy’ and manual aspiration thrombectomy (MAT) alone. Methods: 145 patients with M1 vessel circulation stroke and had undergone thrombectomy treatment were identified between March 2014 and June 2016 in two high volume centers. The patient’s data were retrospectively analyzed to evaluate the technical characteristics, angiographic outcome (Thrombolysis In Cerebral Infarct - TICI score) and clinical outcome at discharge (NIHSS and mRS) Results: 69 patients were treated with ST (Solitaire and Trevo) and 76 with MAT. IV-TPA was administered in 37.4% of cases. Effective recanalization, TICI grades 2b/3, was achieved in 84.1% of cases treated with ST and in 89.5% treated with aspiration with no statistical significance between the two techniques. Symptomatic cerebral hemorrhage was found in 4.3% of the cases. Favorable outcome defined as a mRS of 0-2 at discharge was found in 38% of cases with higher rates in the group treated with ST (56.1% vs 33.3%; p 0.01). Conclusion: Stent retriever mediated manual aspiration thrombectomy is a safe and efficacious method of achieving high revascularization rates for M1 vessel occlusion with improved outcomes at discharge.

scholarly journals Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices

2021 ◽  
Vol 12 ◽  
Author(s):  
Leonard L. L. Yeo ◽  
Mingxue Jing ◽  
Pervinder Bhogal ◽  
Tianming Tu ◽  
Anil Gopinathan ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Standard Of Care ◽  
Late Presentation ◽  
Vessel Occlusion ◽  
New Techniques ◽  
Endovascular Thrombectomy ◽  
Stent Retrievers ◽  
Tandem Lesions ◽  
Novel Devices ◽  
Improve Patient

Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS) and is now the standard of care according to international guidelines. However, in about 20% of EVT procedures, recanalization is not achieved, and over 50% of patients who undergo EVT still do not have good functional outcome. In this article, we provide an extensive review of the latest evidence and developments in the field of EVT, with particular focus on the factors that improve patient outcomes. These factors include new and adjunctive techniques such as combination of direct aspiration and stent retriever, intra-arterial urokinase or 2b/3a inhibitors, rescue stenting, as well as novel devices including balloon guide catheters and the newer generations of aspiration catheters and stent retrievers. We also examined the latest notion of using first-pass effect (FPE) as the target to achieve during EVT, which has been associated with an improved functional outcome. While the field of EVT has been rapidly evolving, further research is required in specific AIS patient populations such as those with large ischemic core, late presentation beyond 24 h, posterior circulation strokes, and with distal medium vessel occlusion or tandem lesions to better assess its efficacy and safety.

Abstract TMP12: Aspiration Thrombectomy Works Better Wn Time from Stroke Onset to Clot Contact is Shorter

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Raphael Blanc ◽  
Hocine Redjem ◽  
Gabriele Ciccio ◽  
Stanislas Smadja ◽  
Jean Philippe Desilles ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Occlusion ◽  
Stroke Onset ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Two Factors ◽  
Procedural Complications ◽  
Stent Retrievers ◽  
Large Retrospective Study

Background and Purpose: The technique of A Direct Aspiration, First Pass for the Endovascular Treatment of Stroke (ADAPT) has been reported to be fast, safe and effective for the treatment of acute ischemic stroke(AIS). The aim of this study is to determine the preoperative factors that affect success of the aspiration component of the technique in ischemic stroke patients with large vessel occlusion in the anterior circulation. Methods: We enrolled all 347 consecutive patients with anterior circulation AIS admitted for mechanical thrombectomy (MT) at our institution from August 2013 to October 2015 and treated by ADAPT. Baseline and procedural characteristics, mTICI scores and 3-month mRS were captured and analyzed. Results: Among the 347 patients (occlusion sites: MCA=200, 58%; ICA Siphon=89, 25%; Tandem=58, 17%), aspiration component led to successful reperfusion (mTICI 2b/3 scores) in 56% (193/347 patients), stent retrievers were required in 40 % and a total successful final reperfusion rate of 83% (288/345) was achieved. Overall mRS 0-2 at 90 days was reported in 45% (144/323). Only two factors positively influenced the success of the aspiration component: an isolated MCA occlusion ( p< 0.001) and a shorter time from stroke onset to clot contact ( p= 0.018). Overall procedural complications occurred in 13.3% of patients (48/345). Conclusion: In this large retrospective study, ADAPT technique was shown to be safe and effective for anterior circulation AIS with a final successful reperfusion achieved in 83%. Delay from onset to clot contact and the site of arterial occlusion were predictors for reperfusion.

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