Safety and Effectiveness of the New Generation APERIO® Hybrid Stent-retriever Device in Large Vessel Occlusion Stroke

Comparison of the Aperio Hybrid® and Solitaire FR/X® stents for anterior circulation stroke thrombectomy across different time periods: A propensity score-matched analysis of recanalization and symptomatic hemorrhage

IntroductionThrombectomy has become the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusions (LVOs). The Aperio Hybrid (Acandis, Pforzheim, Germany) is a new stent retriever designed to enhance the effectiveness of this treatment. However, this new stent has not yet been compared to other thrombectomy devices in a clinical setting. The aim of this study was to compare the Aperio Hybrid® with the Solitaire™ FR/X (Medtronic, Minneapolis, USA) during thrombectomy in patients with AIS due to anterior circulation LVO.Materials and methodsWe analyzed data from a multicenter registry of thrombectomy for anterior circulation LVO. Patients with carotid/M1 or proximal M2 occlusions who underwent thrombectomy with either the Aperio Hybrid® or Solitaire™ FR/X® were compared using propensity-score matching (PSM). The primary outcome was the recanalization rate, measured by the Treatment in Cerebral Ischemia (TICI) score of 2b-3, while the secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH).ResultsAmong 455 patients treated, after PSM, 258 patients (129 per group) were analyzed. The adjusted recanalization rates (TICI 2b-3) for the Aperio Hybrid and Solitaire FR/X were 79.8% and 75.9%, respectively (p = .08), while the adjusted sICH rates were 6.9% and 6.2%, respectively (p = .80).ConclusionsIn this observational study on thrombectomy for AIS, the Aperio Hybrid and Solitaire FR/X demonstrated similar rates of recanalization and symptomatic intracranial hemorrhage. However, due to significant selection bias, these results should be interpreted with caution.

Thrombectomy for Anterior Circulation Stroke with a Hybrid Cell Design Stent Retriever: A Multicenter Registry

Objective

Thrombectomy is the standard recanalization treatment for acute ischemic stroke (AIS) due to large vessel occlusions (LVO). However, thrombectomy was validated using a few brands of devices. New types of thrombectomy devices have been developed, and assessing their safety and efficacy is essential. This study aimed to evaluate the safety and efficacy of thrombectomy with the Aperio Hybrid stent retriever (Acandis, Pforzheim, Germany) in the treatment of patients with AIS due to anterior circulation LVO.

Methods

This was a multicenter registry of thrombectomy in the treatment of stroke due to anterior circulation LVO. Between January 2022 and January 2024, a total of 128 patients were included.

Results

The mean procedure time was 62 minutes. The rates of the main outcomes were recanalization (extended treatment in cerebral ischemia 2b-3) 102/128 (79.7%), symptomatic intracranial hemorrhage 9/128 (7.0%), good clinical outcome (modified Rankin Scale = 0-2) 67/128 (52.3%), and mortality 24/128 (18.7%) at 3 months.

Conclusion

This study showed that, in a multicenter real-life scenario, the Aperio hybrid stent retriever was safe and effective for thrombectomy of anterior circulation strokes. The outcomes of this study were similar to those of previous large thrombectomy studies.

A prospective, multicentre, registry study of RECO in the endovascular treatment of acute ischaemic stroke

The RECO is a novel endovascular treatment (EVT) device that adjusts the distance between two mesh segments to axially hold the thrombus. We organized this postmarket study to assess the safety and performance of RECO in acute ischaemic stroke (AIS) patients with large vessel occlusion (LVO). This was a single-arm prospective multicentre study that enrolled patients as first-line patients treated with RECO at 9 stroke centres. The primary outcome measures included functional independence at 90 days (mRS 0-2), symptomatic intracranial haemorrhage (sICH), time from puncture to recanalization and time from symptom onset to recanalization. The secondary outcome measures were a modified thrombolysis in cerebral infarction (mTICI) score of 2b or 3 after the first attempt and at the end of the procedure and the all-cause mortality rate within 90 days. From May 22, 2020, to July 30, 2022, a total of 268 consecutive patients were enrolled in the registry. The median puncture-to-recanalization time was 64 (IQR, 45-92), and the symptom onset-to-recanalization time was 328 min (IQR, 228-469). RECO achieved successful reperfusion (mTICI 2b-3) after the first pass in 133 of 268 patients (49.6%). At the end of the operation, 96.6% of the patients reached mTICI 2b-3, and 97.4% of the patients ultimately achieved successful reperfusion. Sixteen (7.2%) patients had sICH. A total of 132 (49.3%) patients achieved functional independence at 90 days, and the all-cause mortality rate within 90 days was 17.5%. In this clinical experience, the RECO device achieved a high rate of complete recanalization with a good safety profile and favourable 90-day clinical outcomes.Clinical trial registration: URL: https://www.clinicaltrials.gov/ ; Unique identifier: NCT04840719.

Safety and Efficacy of the Novel Low-Profile APERIO Hybrid17 for a Treatment of Proximal and Distal Vessel Occlusion in Acute Ischemic Stroke: A Multi-Center Experience

OBJECTIVE

To report our initial experience with the novel low-profile APERIO Hybrid17 Thrombectomy Device (AP17) for proximal and distal vessel occlusions in acute ischemic stroke.

METHODS

A multicentric retrospective analysis of patients treated with the AP17 was performed. The primary effectiveness endpoint was first-pass TICI ≥2b (Thrombolysis in cerebral infarction scale). The primary safety endpoint was the occurrence of hemorrhagic complications. Further outcome measures were number of passes, device-related complications, and 3-month functional outcome.

RESULTS

The AP17 was used in 71 patients (mean age: 73 years) with a median baseline National Institutes of Health Stroke Scale score of 9. Treated vessels were the carotid-T in 8 cases (11%), the M1-segment in 16 (23%), the M2-segment in 29 (41%), the anterior cerebral artery in 3 (4%), and basilar/posterior cerebral arteries in 15 (21%). The rates of first-pass and final TICI ≥2b were 75.6% and 92.7%, retrospectively, with a mean number of passes of 3 ± 2. Final TICI ≥2b rates were comparable between large and medium vessel occlusions. Symptomatic intracranial hemorrhages were recorded in 2 cases (2.8%). At 3-month clinical follow-up, a modified Rankin scale score ≤2 was achieved in 69.0% (29/42). The all-cause mortality at discharge was 17.4%.

CONCLUSIONS

The AP17 was associated with a reasonable safety and efficacy profile for both proximal and distal vessel occlusions. These results may contribute to establish mechanical thrombectomy for distal occlusions.

In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models

BACKGROUND AND PURPOSE

Achieving complete recanalization with the front-line endovascular thrombectomy device improves the outcome of acute stroke. The aim of this study was to evaluate whether various thrombectomy techniques including contact aspiration, stent retriever thrombectomy, and combination therapy differ in first-pass effect and distal emboli in acute large-vessel occlusion simulated using 3D printed nontortuous and tortuous cerebrovascular anatomy models.

MATERIALS AND METHODS

3D printed flow models were manufactured using angiographic data of nontortuous and acutely angulated tortuous vascular anatomy from real patients. Three thrombectomy techniques, contact aspiration, stent retriever, and combined methods, were tested under proximal protection with the balloon-guiding catheter. The first-pass effect and distal emboli rates were analyzed in addition to the thrombectomy-failure mechanisms of the respective techniques.

RESULTS

A total of 30 thrombectomy experiments were performed. The overall incidence of first-pass effect in the nontortuous and tortuous anatomy was 80.0% versus 46.7%. The overall incidence of distal emboli in the nontortuous and tortuous anatomy was 26.7% versus 46.7%. The contact aspiration technique showed better first-pass effect (80.0%) and distal emboli rates (20%) in the tortuous model compared with other techniques. The combined technique did not show remarkable superiority of the first-pass effect and distal emboli in either the nontortuous or tortuous anatomy. Shearing off of the thrombus was the main mechanism of thrombectomy failure in the combined group.

CONCLUSIONS

The tortuous vascular anatomy may worsen the first-pass effect and distal emboli rates. The combined techniques failed to show improvement in outcome due to the shearing-off phenomenon of the thrombus during retrieval.