1
|
Zakeri A, Schreiber C, Shah V, VonEnde E, Granger J, Minnema AJ, Constable M, Shujaat T, Youssef P, Powers C, Jankowitz B, Nimjee SM. Utility of the novel guide catheter in mechanical thrombectomy for emergent large vessel occlusion stroke. Interv Neuroradiol 2024; 30:336-341. [PMID: 35642272 PMCID: PMC11310718 DOI: 10.1177/15910199221084483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A number of large bore guide catheters are currently available for use in neuroendovascular surgery. This study represents a multi-institutional retrospective series of patients undergoing mechanical thrombectomy with the use of a TracStar Large Distal Platform (LDP) guide catheter and assessed its performance in vivo in 107 patients. OBJECTIVE To review a multi-institutional initial experience with the TracStar LDP guide catheter during mechanical thrombectomy for emergent large vessel occlusion (ELVO). METHODS A retrospective review was performed at two level one stroke centres to include all patients who underwent mechanical thrombectomy and had the TracStar LDP guide catheter used during the intervention. RESULTS The TracStar LDP guide catheter was successfully used in 107 mechanical thrombectomies. In anterior circulation ELVO, the guide catheter advanced into the cavernous segment of the internal carotid artery in 62.6% (62/99) of cases. In posterior circulation cases, the guide catheter advanced to the basilar artery in 87.5% (7/8) of cases. A thrombolysis in cerebral infarction 2b or greater reperfusion was obtained in 90.7% (97/107). No complications occurred related to the TracStar LDP guide catheter. Three complications occurred with aspiration catheters including a small dissection that did not require further intervention and fracturing of the AXS Catalyst 6 catheter tip in two cases. No thromboembolic events occurred. CONCLUSIONS The TracStar LDP large bore guide catheter is safe and effective at navigating the tortuous vascular anatomy often encountered during mechanical thrombectomy for stroke. The flexible distal and stiffer proximal components provide a good combination of navigability and support for use in neuroendovascular interventions.
Collapse
Affiliation(s)
- Amanda Zakeri
- Department of Neurosurgery, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Craig Schreiber
- Department of Neurosurgery, Cooper University Hospital, 1 Cooper Plaza, Camden, New Jersey 08103
| | - Varun Shah
- Department of Neurosurgery, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Elizabeth VonEnde
- Department of Radiology, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Jessica Granger
- Department of Neuroendovascular Imaging and Perioperative Services, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Amy J Minnema
- Department of Neurosurgery, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Mark Constable
- Department of Neurosurgery, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Taimur Shujaat
- Department of Radiology, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Patrick Youssef
- Department of Neurosurgery, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Ciarán Powers
- Department of Neurosurgery, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| | - Brian Jankowitz
- Department of Neurosurgery, Cooper University Hospital, 1 Cooper Plaza, Camden, New Jersey 08103
| | - Shahid M. Nimjee
- Department of Neurosurgery, The Ohio State University Medical Center, 410 W 10th Ave., Columbus, Ohio 43210
| |
Collapse
|
2
|
Zhiqiang P, Junchen C, Wenying C, Dongqing Z, Mi M, Qiaowei L, Zhenzhen Z, Wanyi H, Biqing Y, Minqi C. Aspiration thrombectomy versus stent retriever thrombectomy as a first-line approach for cardiogenic cerebral embolism and cryptogenic stroke in large vessels of the anterior circulation. Front Neurol 2024; 14:1324725. [PMID: 38288331 PMCID: PMC10824241 DOI: 10.3389/fneur.2023.1324725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024] Open
Abstract
Subject This study aims to compare the clinical efficacy of aspiration thrombectomy and stent retriever thrombectomy as first-line approaches for anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke. Method This retrospective observational study included patients with anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke treated with endovascular therapy. Patients were grouped according to the first-line approach they received: aspiration thrombectomy or stent retriever thrombectomy. The primary outcome measure was the change in the National Institute of Health Stroke Scale (NIHSS) score from preoperative to immediate postoperative and from preoperative to discharge. Secondary indicators included the rate of favorable prognosis at discharge [Modified Rankin Scale (mRS) score ≤ 2], successful vessel recanalization rate [modified Treatment in Cerebral Ischemia (mTICI) score ≥ 2b], time from successful femoral artery puncture to successful vessel recanalization, and perioperative complications. Result The study included 127 cases, with 1 case withdrawal after enrollment due to a stroke of another determined cause, with 83 in the aspiration thrombectomy group and 43 cases in the stent retriever thrombectomy group. The change in NIHSS score from preoperative to immediate postoperative was 5 (1, 8) in the aspiration thrombectomy group and 1 (0, 4.5) in the stent retriever thrombectomy group. The change from preoperative to discharge was 8 (5, 12) in the aspiration thrombectomy group and 4 (0, 9) in the stent retriever thrombectomy group. The aspiration thrombectomy group exhibited significantly better prognosis rates and shorter time from successful femoral artery puncture to successful vessel recanalization. There were no significant differences between the two groups in terms of successful vessel recanalization rates and perioperative complications. Conclusion As a first-line approach for anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke, aspiration thrombectomy leads to better improvement in neurological functional deficits and prognosis rates compared to stent retriever thrombectomy.
Collapse
Affiliation(s)
- Peng Zhiqiang
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Chen Junchen
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Cao Wenying
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Zhao Dongqing
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Ma Mi
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Li Qiaowei
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Zhu Zhenzhen
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - He Wanyi
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Yang Biqing
- Department of Stroke Center, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Cao Minqi
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
3
|
Massari F, Dabus G, Cortez GM, Singh J, Kuhn AL, Naragum V, Anagnostakou V, Hanel RA, Gounis MJ, Puri AS. Super large-bore ingestion of clot (SLIC) leads to high first pass effect in thrombectomy for large vessel occlusion. J Neurointerv Surg 2022:neurintsurg-2022-018806. [PMID: 35732483 DOI: 10.1136/neurintsurg-2022-018806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Super large-bore aspiration (SLBA) has shown high rates of complete clot ingestion. OBJECTIVE To report the initial clinical feasibility, safety, and efficacy of this novel SLBA insert combination-super large-bore ingestion of clot (SLIC) technique for stroke. METHODS We performed a retrospective review of three comprehensive stroke center databases. The SLIC technique entails a triaxial assembly of an 8 Fr 0.106″ Base Camp catheter, 0.088″ catheter extender (HiPoint), and an insert catheter (Tenzing 8) that completely consumes the inner diameter of the 0.088″ SLBA catheter. The HiPoint catheter is delivered over the Tenzing 8 to the face of the embolus, which is withdrawn, while aspirating through the Base Camp and HiPoint catheters as a single assembly. RESULTS Thirty-three consecutive patients with large vessel occlusion were treated with SLIC. The median age was 70 years (30-91) and 17 were male (51.5%). The median presenting National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT score was 21 (1-34) and 8 (5-10), respectively. There was 100% success in delivering the 0.088″ catheter to the site of the occlusion. The successful revascularization rate (modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B) was 100% within a single pass in most cases (82%). Final mTICI ≥2C was achieved in 94.1% of occlusions, with 73.5% mTICI 3 recanalization. The rate of first pass effect in achieving excellent reperfusion (mTICI ≥2C) was 70.5%. There were no adverse events or postprocedural symptomatic hemorrhages. CONCLUSIONS Our initial experience with the SLIC technique resulted in achieving a first pass effect (mTICI ≥2C) in 70.5%. Navigation of the SLBA catheter extender over the Tenzing insert was successful and safe in this early experience.
Collapse
Affiliation(s)
- Francesco Massari
- Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.,Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Guilherme Dabus
- Department of Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac & Vascular Institute - Baptist Hospital, Miami, Florida, USA
| | - Gustavo M Cortez
- Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Jasmeet Singh
- Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.,Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Anna Luisa Kuhn
- Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.,Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Varun Naragum
- Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Vania Anagnostakou
- New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Matthew J Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| |
Collapse
|
4
|
Al Saiegh F, Munoz A, Velagapudi L, Theofanis T, Suryadevara N, Patel P, Jabre R, Chen CJ, Shehabeldin M, Gooch MR, Jabbour P, Tjoumakaris S, Rosenwasser RH, Herial NA. Patient and procedure selection for mechanical thrombectomy: Toward personalized medicine and the role of artificial intelligence. J Neuroimaging 2022; 32:798-807. [PMID: 35567418 DOI: 10.1111/jon.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/27/2022] Open
Abstract
Mechanical thrombectomy (MT) for ischemic stroke due to large vessel occlusion is standard of care. Evidence-based guidelines on eligibility for MT have been outlined and evidence to extend the treatment benefit to more patients, particularly those at the extreme ends of a stroke clinical severity spectrum, is currently awaited. As patient selection continues to be explored, there is growing focus on procedure selection including the tools and techniques of thrombectomy and associated outcomes. Artificial intelligence (AI) has been instrumental in the area of patient selection for MT with a role in diagnosis and delivery of acute stroke care. Machine learning algorithms have been developed to detect cerebral ischemia and early infarct core, presence of large vessel occlusion, and perfusion deficit in acute ischemic stroke. Several available deep learning AI applications provide ready visualization and interpretation of cervical and cerebral arteries. Further enhancement of AI techniques to potentially include automated vessel probe tools in suspected large vessel occlusions is proposed. Value of AI may be extended to assist in procedure selection including both the tools and technique of thrombectomy. Delivering personalized medicine is the wave of the future and tailoring the MT treatment to a stroke patient is in line with this trend.
Collapse
Affiliation(s)
- Fadi Al Saiegh
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alfredo Munoz
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lohit Velagapudi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thana Theofanis
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neil Suryadevara
- Department of Neurology, Upstate Medical University, Syracuse, New York, USA
| | - Priyadarshee Patel
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Roland Jabre
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mohamed Shehabeldin
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Reid Gooch
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Caldwell J, McGuinness B, Lee SS, Barber PA, Holden A, Wu T, Krauss M, Laing A, Collecutt W, Liebeskind DS, Hetts SW, Brew S. Aspiration thrombectomy using a novel 088 catheter and specialized delivery catheter. J Neurointerv Surg 2021; 14:1239-1243. [PMID: 34907007 DOI: 10.1136/neurintsurg-2021-018318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND We 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. METHODS The 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. RESULTS Vessel 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). CONCLUSIONS In 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.
Collapse
Affiliation(s)
- James Caldwell
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
| | - Ben McGuinness
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
| | - Shane S Lee
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
| | - P Alan Barber
- Medicine, University of Auckland, Auckland, New Zealand.,Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Holden
- Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Teddy Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Martin Krauss
- Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - Andrew Laing
- Radiology, Christchurch Hospital, Christchurch, New Zealand
| | | | | | | | - Stefan Brew
- Neuroradiology, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
6
|
Bageac DV, Gershon BS, Shigematsu T, Majidi S, De Leacy RA. Early institutional experience using the TracStar Large Distal Platform in endovascular flow diversion. Neuroradiol J 2021; 35:313-318. [PMID: 34473002 DOI: 10.1177/19714009211041520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The delivery of flow-diverting stents (FDS) necessitates a degree of catheter support beyond that required for endovascular coiling. The TracStar Large Distal Platform (LDP) is a novel 0.088″ platform intended for navigation into the intracranial internal carotid artery (ICA). We present an early institutional experience using the TracStar LDP in 44 cases of endovascular aneurysm embolization using FDS. METHODS Inclusion criteria for this single-center retrospective review encompassed all patients >18 years of age who were treated for intracranial aneurysms. Procedural success was defined as successful stent deployment using the TracStar LDP. Other outcomes included periprocedural complications, use of an intermediate catheter, length of stay, and discharge disposition. RESULTS The TracStar LDP was utilized in 44 consecutive FDS cases in 42 patients. Cavernous segment aneurysms constituted the majority of cases (12/42; 28.6%), followed by posterior communicating artery (8/42; 19.0%) and supraclinoid aneurysms (8/42; 19.0%). Successful FDS deployment was achieved in 43/44 cases. The LDP achieved stable positioning within the ascending cavernous ICA in 63.6% of cases. A biaxial system was utilized in 54.5% of cases. There was one complication potentially related to use of the TracStar LDP, which was an asymptomatic ICA vessel dissection managed conservatively. CONCLUSIONS The TracStar LDP is safe and effective during use in the endovascular treatment of intracranial aneurysms with a FDS. Access to the ascending portion of the cavernous ICA was regularly achieved, and the platform allowed for both biaxial and triaxial configurations.
Collapse
|
7
|
Bageac DV, Gershon BS, De Leacy RA. The Evolution of Devices and Techniques in Endovascular Stroke Therapy. Stroke 2021. [DOI: 10.36255/exonpublications.stroke.devicesandtechniques.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|