Cyclical aspiration using a novel mechanical thrombectomy device is associated with a high TICI 3 first pass effect in large‐vessel strokes

Kalousek, Vladimir; Yoo, Albert J.; Sheth, Sunil A; Janardhan, Vikram; Mamic, Josip; Janardhan, Vallabh

doi:10.1111/jon.12889

Cited by 18 publications

(25 citation statements)

References 42 publications

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“…Knowing this information could help further tease apart patients most likely to benefit from EVT. Finally, while we did not observe a difference in the final rates of successful reperfusion, the rates of eTICI 2b/3 first-pass effect, which is known to be associated with clinical outcome, mortality, and sICH,26 27 were not available. As a result, we are unable to comment on whether this differed between the two groups.…”

Section: Discussioncontrasting

confidence: 63%

Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy

McDonough

Ospel

Majoie

et al. 2022

J NeuroIntervent Surg

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BackgroundAnalyses of the effect of pre-stroke functional levels on the outcome of endovascular therapy (EVT) have focused on the course of patients with moderate to substantial pre-stroke disability. The effect of complete freedom from pre-existing disability (modified Rankin Scale (mRS) 0) versus predominantly mild pre-existing disability/symptoms (mRS 1–2) has not been well delineated.MethodsThe HERMES meta-analysis pooled data from seven randomized trials that tested the efficacy of EVT. We tested for a multiplicative interaction effect of pre-stroke mRS on the relationship between treatment and outcomes. Ordinal regression was used to assess the association between EVT and 90-day mRS (primary outcome) in the subgroup of patients with pre-stroke mRS 1–2. Multivariable regression modeling was then used to test the effect of mild pre-stroke disability/symptoms on the primary and secondary outcomes (delta-mRS, mRS 0–2/5–6) compared with patients with pre-stroke mRS 0.ResultsWe included 1764 patients, of whom 199 (11.3%) had pre-stroke mRS 1–2. No interaction effect of pre-stroke mRS on the relationship between treatment and outcome was observed. Patients with pre-stroke mRS 1–2 had worse outcomes than those with pre-stroke mRS 0 (adjusted common OR (acOR) 0.53, 95% CI 0.40 to 0.70). Nonetheless, a significant benefit of EVT was observed within the mRS 1–2 subgroup (cOR 2.08, 95% CI 1.22 to 3.55).ConclusionsPatients asymptomatic/without disability prior to onset have better outcomes following EVT than patients with mild disability/symptoms. Patients with pre-stroke mRS 1–2, however, more often achieve good outcomes with EVT compared with conservative management. These findings indicate that mild pre-existing disability/symptoms influence patient prognosis after EVT but do not diminish the EVT treatment effect.

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Section: Discussioncontrasting

confidence: 63%

Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy

McDonough

Ospel

Majoie

et al. 2022

J NeuroIntervent Surg

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“…Increasing aspiration cycle frequency (pressure oscillations per second, Hz) can improve the efficacy of clot removal [ 26 ], as cyclical aspiration may be able to induce larger strain on the clots [ 27 ]. Clinical studies reported that cyclical aspiration, also known as pulsatile or intermittent aspiration, could be more effective than continuous uniform aspiration to achieve FPE [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…27 Clinical studies reported that cyclical aspiration, also known as pulsatile or intermittent aspiration, could be more effective than continuous uniform aspiration to achieve FPE. 28,29 • The utilization of balloon guide catheter: the combined effect of proximal flow arrest and distal aspiration can reduce the number of passes, time from puncture to recanalization, and periprocedural embolization. 30,31 Three force components act on a lodged thrombus and hinder clot removal: the impaction force exerted by the systemic pressure on the proximal face of the clot, the adhesion force, and the friction force between the thrombus and vessel wall.…”

Section: Discussionmentioning

confidence: 99%

REACT Aspiration Catheters: Clinical Experience and Technical Considerations

Li¹,

Ribó²

2022

Neurointervention

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Aspiration catheters are widely used in mechanical thrombectomy procedures to treat acute ischemic stroke due to large vessel occlusion. The key performance requirements for aspiration catheters are ease of navigation and effective aspiration. In this work, we review the clinical experience and in vitro studies of REACT aspiration catheters (Medtronic, Minneapolis, MN, USA). In vitro experiments showed that REACT catheters exhibit solid performance in navigation and aspiration. Previous studies reported that the recanalization capacity of the aspiration catheters can be influenced by the devices’ inner diameter and tip distensibility, the catheter-to-vessel diameter ratio, the negative pressure delivered by the vacuum generator, the cyclical aspiration mode, the proximal flow arrest, and the angle of interaction between catheter and clot. REACT catheters can be navigated through the vasculature without any support from a microcatheter/ microwire in favorable anatomical configurations. In challenging situations, mostly encountered when crossing the ophthalmic segment of the internal carotid artery, the use of the stentriever anchoring technique or delivery assist catheter can facilitate the navigation. Three clinical studies reporting on 299 patients who underwent mechanical thrombectomy with REACT catheters were included in this review. Successful recanalization (modified treatment in cerebral ischemia score 2b–3) was achieved in 89–96% of cases, no procedural complications related to REACT catheters were reported, and functional independence (modified Rankin Scale 0–2) at 90-days was 24–36%. In vitro experimental evaluations and clinical studies support the safety and effectiveness of the REACT catheters.

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“…This method was used previously 10 20 21. Furthermore, since first-pass effect (FPE) reperfusions have been shown to be an important predictor for good clinical outcome after EVT,22–24 we performed additional analyses (see online supplemental table 3) using FPE as an independent variable. We defined FPE as eTICI 2b–3 achieved with one attempt and non-FPE as any other post-eTICI achieved or an eTICI 2b–3 achieved with multiple attempts.…”

Section: Methodsmentioning

confidence: 99%

Benefit of successful reperfusion achieved by endovascular thrombectomy for patients with ischemic stroke and moderate pre-stroke disability (mRS 3): results from the MR CLEAN Registry

Benali

Kappelhof

Ospel

et al. 2022

J NeuroIntervent Surg

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BackgroundPre-stroke dependent patients (modified Rankin Scale score (mRS) ≥3) were excluded from most trials on endovascular treatment (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Therefore, little evidence exists for EVT in those patients. We aimed to investigate the safety and benefit of EVT in pre-stroke patients with mRS score 3.MethodsWe used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in the Netherlands (MR CLEAN) Registry. All patients treated with EVT for anterior circulation AIS with pre-stroke mRS 3 were included. We assessed causes for dependence and compared patients with successful reperfusion (defined as expanded Thrombolysis in Cerebral Ischemia scale (eTICI) 2b–3) to patients without successful reperfusion. We used regression analyses with pre-specified adjustments. Our primary outcome was 90-day mRS 0–3 (functional improvement or return to baseline).ResultsA total of 192 patients were included, of whom 82 (43%) had eTICI <2b and 108 (56%) eTICI ≥2b. The median age was 80 years (IQR 73–87). Fifty-one of the 192 patients (27%) suffered from previous stroke and 36/192 (19%) had cardiopulmonary disease. Patients with eTICI ≥2b more often returned to their baseline functional state or improved (n=26 (26%) vs n=15 (19%); adjusted odds ratio (aOR) 2.91 (95% CI 1.08 to 7.82)) and had lower mortality rates (n=49 (49%) vs n=50 (64%); aOR 0.42 (95% CI 0.19 to 0.93)) compared with patients with eTICI <2b.ConclusionsAlthough patients with AIS with pre-stroke mRS 3 comprise a heterogenous group of disability causes, we observed improved outcomes when patients achieved successful reperfusion after EVT.

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Cyclical aspiration using a novel mechanical thrombectomy device is associated with a high TICI 3 first pass effect in large‐vessel strokes

Cited by 18 publications

References 42 publications

Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy

Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy

REACT Aspiration Catheters: Clinical Experience and Technical Considerations

Benefit of successful reperfusion achieved by endovascular thrombectomy for patients with ischemic stroke and moderate pre-stroke disability (mRS 3): results from the MR CLEAN Registry

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