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Goldman D, Al-Kawaz M, Reddi P, Yaeger KA, Hardigan T, Mehta A, Scaggiante J, Tomalty RD, Gulotta P, Fennell V, Vidal GA, Poongkunran M, Milburn JM, Majidi S. Higher intracranial positioning of an 8 Fr guide catheter improves efficacy of aspiration thrombectomy in large vessel occlusion stroke. J Neurointerv Surg 2024:jnis-2024-022026. [PMID: 39299745 DOI: 10.1136/jnis-2024-022026] [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: 05/24/2024] [Accepted: 08/31/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Higher positioning of a large bore guide catheter during endovascular thrombectomy (EVT) is hypothesized to potentially improve thrombectomy success. OBJECTIVE To evaluate the safety and efficacy of intracranial guide catheter placement during EVT using a multicenter database. METHODS We reviewed data on consecutive patients undergoing EVT for anterior circulation large vessel occlusion (LVO) at three comprehensive stroke centers between October 2019 and December 2022. Participants were allocated to one of two cohorts: intracranial (n=141)-guide catheter tip positioned in the petrous carotid or further distal; and control (n=285)-guide catheter tip below the petrous carotid. Primary outcome was excellent reperfusion (Thrombolysis in Cerebral Ischemia (TICI) 2c or better), first pass effect (TICI 2c or better after one pass), and arterial access to final reperfusion time. The unpaired t-test, Mann-Whitney U test, and Fisher's exact test were used to compare themeans, medians and proportions of the two groups, respectively. P values & lt;0.05 were considered statistically significant two cohorts. RESULTS A total of 426 patients were included in the analysis. Patients with guide catheter location in the petrous segment or further distal had a significantly higher first-pass effect (111/284, 39.1% vs 37/141, 26.2%, P=0.009). There was no significant difference in final excellent recanalization rates between groups (202/285, 70.9% vs 92/141, 65.2%, P=0.266). Furthermore, intracranial positioning of the guide catheter was associated with significantly shorter time to final recanalization (median 21.0 (13.0-38.0) min vs 30.0 (17.0-48.0) min, P<0.001). CONCLUSION Positioning a large bore guide catheter in the petrous segment or further distal resulted in a significantly higher rate of first pass effect, faster procedural times, and equivalent final excellent reperfusion rates compared with more proximal guide catheter placement for patients with anterior circulation LVO.
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Affiliation(s)
- Daryl Goldman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mais Al-Kawaz
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - Preethi Reddi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kurt A Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Trevor Hardigan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amol Mehta
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacopo Scaggiante
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Paul Gulotta
- Department of Radiology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Vernard Fennell
- Department of Radiology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Gabriel A Vidal
- Department of Neurology, Ochsner Health Network LLC, New Orleans, Louisiana, USA
| | - Mugilan Poongkunran
- Department of Radiology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - James M Milburn
- Department of Radiology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Navia P, Espinosa de Rueda M, Rodriguez-Benitez A, Ballenilla Marco F, Pumar JM, Gallego-Leon JI, Diaz-Valiño JL, Mendez JC, Hernández Fernández F, Rodriguez-Paz CM, Hernandez D, Maynar FJ, Vega-Villar J, García-Benassi JM, Martínez-Galdámez M, Larrea JA, Fernandez-Prieto A. Endovascular thrombectomy first-pass reperfusion and ancillary device placement. J Neurointerv Surg 2024; 16:902-907. [PMID: 37607823 DOI: 10.1136/jnis-2023-020433] [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: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT). METHODS Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device. RESULTS From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0-2). CONCLUSIONS Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.
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Affiliation(s)
- Pedro Navia
- Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
- La Paz University Hospital Health Research Institute, Madrid, Spain
| | | | | | | | - José Manuel Pumar
- Neuroradiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Ignacio Gallego-Leon
- Alicante General University Hospital, Alicante, Spain
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | | | - Jose Carlos Mendez
- Interventional Neuroradiology Unit. Radiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Interventional Neuroradiology.Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain
| | - Jose-Angel Larrea
- Interventional Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Andres Fernandez-Prieto
- Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
- La Paz University Hospital Health Research Institute, Madrid, Spain
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3
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Pradhan A, Mut F, Sosale M, Cebral J. Flow reduction due to arterial catheterization during stroke treatment - A computational study using a distributed compartment model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024:e3853. [PMID: 39090842 DOI: 10.1002/cnm.3853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/07/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024]
Abstract
The effectiveness of various stroke treatments depends on the anatomical variability of the cerebral vasculature, particularly the collateral blood vessel network. Collaterals at the level of the Circle of Willis and distal collaterals, such as the leptomeningeal arteries, serve as alternative avenues of flow when the primary pathway is obstructed during an ischemic stroke. Stroke treatment typically involves catheterization of the primary pathway, and the potential risk of further flow reduction to the affected brain area during this treatment has not been previously investigated. To address this clinical question, we derived the lumped parameters for catheterized blood vessels and implemented a corresponding distributed compartment (0D) model. This 0D model was validated against an experimental model and benchmark test cases solved using a 1D model. Additionally, we compared various off-center catheter trajectories modeled using a 3D solver to this 0D model. The differences between them were minimal, validating the simplifying assumption of the central catheter placement in the 0D model. The 0D model was then used to simulate blood flows in realistic cerebral arterial networks with different collateralization characteristics. Ischemic strokes were modeled by occlusion of the M1 segment of the middle cerebral artery in these networks. Catheters of different diameters were inserted up to the obstructed segment and flow alterations in the network were calculated. Results showed up to 45% maximum blood flow reduction in the affected brain region. These findings suggest that catheterization during stroke treatment may have a further detrimental effect for some patients with poor collateralization.
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Affiliation(s)
- Aseem Pradhan
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
| | - Fernando Mut
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
| | - Medhini Sosale
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
| | - Juan Cebral
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
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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.
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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
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5
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Findlay MC, Bounajem M, Grandhi R. Correspondence on 'Matched-pair analysis of patients with ischemic stroke undergoing thrombectomy using next-generation balloon guide catheters' by Kim et al. J Neurointerv Surg 2024; 16:632-633. [PMID: 38124175 DOI: 10.1136/jnis-2023-021342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Matthew C Findlay
- Spencer Fox Eccles School of Medicine, University of Utah Health, Salt Lake City, Utah, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Michael Bounajem
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
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Saei HM, Miller SE, Pope HM, Hassan AE. Fubuki XF Long Sheath guide catheter use in neuroendovascular procedures: Institutional experience in 60 cases. Interv Neuroradiol 2024:15910199241245601. [PMID: 38592015 DOI: 10.1177/15910199241245601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Endovascular treatment devices require compatible guide catheters to navigate complex vessels and anatomy. The Fubuki XF Long Sheath guide catheter (Fubuki XF) was developed with a 0.090-inch internal diameter with hydrophilic coating, an atraumatic rounded tip, and enhanced trackability and support with gradual shaft transition zones. METHODS We retrospectively analyzed a prospectively maintained database of neuroendovascular patients treated using Fubuki XF at our center (July 2022─May 2023). Baseline/procedural characteristics were collected. Outcomes of interest included technical success (procedure completion with Fubuki XF without alternative guide catheter use) and peri-procedural complications. RESULTS This study included 60 patients (43.3% [26/60] female; mean age: 69.6 ± 9.7) presenting with stenosis (45.0% [27/60]), unruptured aneurysms (31.7% [19/60]), ruptured aneurysm (1.7% [1/60]), arteriovenous fistula (5.0% [3/60]), arteriovenous malformation (3.3% [2/60]), chronic subdural hematoma (3.3% [2/60]), stroke/emboli (6.7% [4/60]), vasospasm (1.7% [1/60]), or carotid web (5.0% [1/60]). Fubuki XF was used to deliver endovascular treatment devices for stenting (43.3% [26/60]), flow diversion (23.3% [14/60]), embolization (11.7% [7/60]), coiling (10.0% [6/60]), balloon angioplasty (10.0% [6/60]), and mechanical thrombectomy (1.7% [1/60]). The Fubuki XF tip was placed in the internal carotid artery in 38.3% (23/60) of cases. Technical success was achieved in all cases. One V1 non-flow-limiting dissection (not related to Fubuki XF) and one failed closure occurred (1.7% [1/60] each). No iatrogenic strokes or intraprocedural ruptures occurred. CONCLUSION We used Fubuki XF to safely and effectively deliver a variety of compatible neuroendovascular devices. Fubuki XF was stable in all cases and locations, and there were no device-related complications or dissections.
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Affiliation(s)
- Hamzah M Saei
- Department of Vascular Neurology, Rio Grande Regional Hospital, McAllen, TX, USA
| | - Samantha E Miller
- Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | | | - Ameer E Hassan
- Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
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Campos JK, Meyer BM, Khan MW, Laghari FJ, Zarrin DA, Collard de Beaufort J, Amin G, Golshani K, Bender MT, Colby GP, Lin LM, Coon AL. Feasibility of super-bore 0.088″ mechanical thrombectomy in M1 vessels smaller than 8 French: Experience in 20 consecutive cases. Interv Neuroradiol 2024:15910199241229198. [PMID: 38418397 DOI: 10.1177/15910199241229198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Superbore 0.088″ catheters provide a platform for optimizing aspiration efficiency and flow control during stroke mechanical thrombectomy procedures. New superbore catheters have the distal flexibility necessary to navigate complex neurovascular anatomy while providing the proximal support of traditional 8F catheters. The safety and feasibility of Zoom 88™ superbore angled-tip catheters in the middle cerebral artery (MCA) segments smaller than the catheter diameter have not been previously described. METHODS Twenty consecutive cases of acute MCA mechanical thrombectomy were retrospectively identified from the senior authors' prospectively maintained Institutional Review Board-approved database, in which the Zoom 88 (Imperative Care, Campbell, CA) catheter was successfully navigated to at least the M1 segment. Patient demographics, procedural details, and periprocedural information were analyzed. Rates and averages (standard errors) are generally reported. RESULTS The average National Institutes of Health Stroke Scale at presentation and age were 15 ± 2 and 73 ± 3 years, respectively. The M1 and M2 occlusions were evenly distributed. The average M1 measurements before thrombectomy ranged from 2.36 ± 0.07 mm proximally to 2.00 ± 0.11 mm distally, and after thrombectomy, they ranged from 2.34 ± 0.07 mm proximally to 1.97 ± 0.10 mm distally. First-pass modified thrombolysis in cerebral infarction (mTICI) 2C/3 recanalization was achieved in 40% of cases, and final mTICI 2C/3 recanalization was achieved in 90% of cases. A single case of mild vasospasm was managed with verapamil. No hemorrhagic or periprocedural complications were noted. CONCLUSION Superbore 0.088″ catheters with flexible distal segments can be safely navigated to the MCA to augment mechanical thrombectomy even when the MCA segment is smaller than the catheter.
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Affiliation(s)
- Jessica K Campos
- Department of Neurological Surgery, University of California Irvine, Orange, CA, USA
| | | | | | - Fahad J Laghari
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
| | - David A Zarrin
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Gizal Amin
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
| | - Kiarash Golshani
- Department of Neurological Surgery, University of California Irvine, Orange, CA, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA
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Gupta R, Miralbés S, Calleja Bonilla A, Naravetla B, Majjhoo AQ, Rayes M, Spiotta AM, Loehr C, Cioltan A, Vollherbst DF, Martínez-Galdámez M, Galván-Fernandez J, Khaldi A, McTaggart RA, Jayaraman MV, Defreyne L, Dhondt E, Vega P, Murias E, Lin E, Chaubal V, Price LL, Liebeskind DS, Möhlenbruch MA. Technique and impact on first pass effect primary results of the ASSIST global registry. J Neurointerv Surg 2024:jnis-2023-021126. [PMID: 38195248 DOI: 10.1136/jnis-2023-021126] [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: 10/12/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Patients treated with mechanical thrombectomy (MT) for acute ischemic strokes from large vessel occlusion (LVO) have better outcomes with effective reperfusion. However, it is unknown which technique leads to better technical and clinical success. We aimed to determine which technique yields the most effective first pass reperfusion during MT. METHODS In a prospective, multicenter global registry we enrolled patients treated with operator preferred MT technique at 71 hospitals from January 2019 to January 2022. Three techniques were assessed: SR Classic with stent retriever (SR) and balloon guide catheter (BGC); SR Combination which employed SR with contact aspiration with or without BGC; and direct aspiration (DA) with or without BGC. The primary outcome was achieving an expanded Thrombolysis In Cerebral Infarction (eTICI) score of 2c or 3 on the first pass, with the primary technique as adjudicated by core lab. The primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2. RESULTS A total of 1492 patients were enrolled. Patients treated with SR Classic or SR Combination were more likely to achieve first pass eTICI 2c or 3 reperfusion (P=0.01). There was no significant difference in mRS 0-2 (P=0.46) or safety endpoints. CONCLUSIONS The use of SR Classic or SR Combination was more likely to achieve first pass eTICI 2c or 3 reperfusion. There were no significant differences in clinical outcomes and safety endpoints.
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Affiliation(s)
- Rishi Gupta
- Neurosurgery, WellStar Health System, Marietta, Georgia, USA
| | - Salvador Miralbés
- Neuroradiology, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Angel Calleja Bonilla
- Neuroradiology, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | | | | | - Mahmoud Rayes
- McLaren Regional Medical Center, Flint, Michigan, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest GmbH, Recklinghausen, Nordrhein-Westfalen, Germany
| | - Andreea Cioltan
- Department of Radiology and Neuroradiology, Klinikum Vest GmbH, Recklinghausen, Nordrhein-Westfalen, Germany
| | | | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain
- Interventional Neuroradiology.Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain
| | - Jorge Galván-Fernandez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain
| | - Ahmad Khaldi
- Neurosurgery, WellStar Health System, Marietta, Georgia, USA
| | | | - Mahesh V Jayaraman
- Diagnostic Imaging, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Luc Defreyne
- Vascular and Interventional Radiology, University Hospital Ghent, Ghent, Belgium
| | - Elisabeth Dhondt
- Vascular and Interventional Radiology, University Hospital Ghent, Ghent, Belgium
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eugene Lin
- Mercy Health Saint Vincent Medical Center, Toledo, Ohio, USA
| | - Varun Chaubal
- Mercy Health Saint Vincent Medical Center, Toledo, Ohio, USA
| | - Lori Lyn Price
- Clinical Affairs, Stryker Neurovascular, Fremont, California, USA
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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9
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Lee IH, Ha SK, Lim DJ, Choi JI. Distal placement of balloon guide catheter facilitates stent-retriever mechanical thrombectomy for acute ischemic stroke in the anterior circulation. Acta Neurochir (Wien) 2023; 165:3759-3768. [PMID: 37816916 DOI: 10.1007/s00701-023-05818-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Although balloon guide catheters (BGCs) have been demonstrated to improve recanalization and functional outcomes by enabling proximal flow control and forced aspiration during mechanical thrombectomy (MT), the significance of the BGC location has been overlooked. We evaluated the impact of BGC location during MT for anterior circulation acute ischemic stroke (AIS). METHODS Patients were divided into the proximal and distal BGC groups according to the BGC tip location relative to the lower margin of the C1 vertebral body. Endovascular and clinical outcomes were compared between the two groups, including subgroup analyses of the two types of extracranial internal carotid artery (ICA) anatomy, categorized based on cerebral angiography. RESULTS A total of 124 patients were analyzed, with 62 each in the proximal and distal BGC placement groups. The distal BGC group had higher rates of first-pass recanalization (FPR) (38.7% vs. 17.7%, P = 0.009) and favorable outcomes (64.5% vs. 46.8%, P = 0.047) with shorter procedure time (47.5 min vs. 65 min, P = 0.001) and fewer distal embolization (3.2% vs. 12.9%, P = 0.048) than the proximal BGC group. FPR was also more frequently achieved in the distal BGC group of patients with tortuous ICA (37.0% vs. 12.5%, P = 0.029). Multivariate analysis showed that distal BGC placement was an independent predictor of FPR (odds ratio, 3.092; 95% confidence interval, 1.326-7.210; P = 0.009). CONCLUSION Distal BGC placement facilitates MT for AIS in the anterior circulation. Therefore, we suggest distal BGC placement to maximize the effect of thrombectomy, even for tortuous extracranial ICA.
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Affiliation(s)
- In-Hyoung Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Gyeonggi-Do, Korea.
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Ezzeldin M, Ota R, Riha E, Delora A, Alenzi B, Gordon V, Gupta H, Ezzeldin R, Bushnaq S. Use of angled-tip aspiration catheters is associated with a lower cost of thrombectomy in patients with acute ischemic stroke secondary to large and medium vessel occlusions. Interv Neuroradiol 2023:15910199231198914. [PMID: 37817546 DOI: 10.1177/15910199231198914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Recently, the angled-tip Zoom™ aspiration catheters were introduced. The tip is designed to improve suction force for clot retrieval. We evaluated the possibility of reducing procedure costs when using angled-tip catheters and compared the safety and angiographic effectiveness of angled-tip versus straight-tip catheters. METHODS We conducted a retrospective single-center cohort study involving patients with acute ischemic stroke due to large and medium vessel occlusions. The patients were divided into two groups: the post-Zoom group, in which angled-tip aspiration catheters were used and the pre-Zoom group, in which traditional straight-tip catheters were employed. RESULTS A total of 163 patients were included; 95 (58.3%) in the pre-Zoom group and 68 (41.7%) in the post-Zoom group. The groups were well-matched at entry. The post-Zoom group demonstrated a significant decrease in mean procedure cost ($9728 vs. $12,127; p = 0.002), shorter time to achieve modified thrombolysis in cerebral infarction ≥2b reperfusion (38.30 min vs. 53.26 min; p = 0.018), and shorter puncture to procedure completion time (46.42 min vs. 62.38 min; p = 0.022). Additionally, the mean procedural cost when using the ADAPT technique supported by the Zoom catheters was significantly lower than the Solumbra technique ($5754 ± $2806 vs. $13,498 ± $3244, p < 0.001). There were no differences in the rate of hemorrhage between the pre-Zoom group (17.9%) and the post-Zoom group (20.6%), p = 0.690. CONCLUSION The study demonstrated significant benefits, including cost reduction and shorter time to achieve reperfusion in patients treated with Zoom aspiration catheters. These findings support the use of angled-tip catheters in acute ischemic stroke management.
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Affiliation(s)
- Mohamad Ezzeldin
- Neuroendovascular Surgery Department, HCA Houston Healthcare Kingwood, Kingwood, TX, USA
| | - Riichi Ota
- Neurology Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Eric Riha
- Internal Medicine, HCA Houston Healthcare Kingwood, Kingwood, TX, USA
| | - Adam Delora
- Emergency Department, HCA Houston Healthcare Kingwood, Kingwood, TX, USA
| | - Bader Alenzi
- Adult Neurology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Victoria Gordon
- Emergency Department, HCA Houston Healthcare Kingwood, Kingwood, TX, USA
| | - Himanshu Gupta
- Emergency Department, HCA Houston Healthcare Kingwood, Kingwood, TX, USA
| | - Rime Ezzeldin
- Faculty of Medicine, Jordan University of Science and Technology, Ar-Ramtha, Irbid, Jordan
| | - Saif Bushnaq
- Neurology Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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