Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique

Pérez-García, Carlos; Maegerlein, Christian; Rosati, Santiago; Rüther, C; Gómez-Escalonilla, Carlos; Zimmer, Claus; Arrazola, Juan; Berndt, Maria; Moreu, Manuel

doi:10.1136/svn-2020-000833

Cited by 20 publications

(11 citation statements)

References 31 publications

(27 reference statements)

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“…Since then, several studies comparing larger and smaller bore aspiration catheters have shown improved outcomes, shorter procedure times, and a lower likelihood of using additional devices without impacting complication rates with a larger bore. 25,38 This relates not only to increased suction force at clots with larger IDs, but also increased aspiration flow rate with decreasing catheter size to vessel diameter ratio. 26 Consequently, design and engineering improvements have permitted a trend in increasing catheter distal ID without clinically significant sacrifices in navigability, pushability, and durability in most instances.…”

Section: Discussionmentioning

confidence: 99%

AXS Vecta 0.071–0.074 Inch Aspiration Catheters for Mechanical Thrombectomy: Case Series and Literature Review

2023

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Aspiration catheters are widely used for thrombectomy either alone or in combination with a stent-retriever, with a distal inner diameter and trackability keys to their success. In an illustrative case series, we report our clinical experience with AXS Vecta (Stryker Neurovascular, Fremont, CA, USA), available in both 0.071-inch and 0.074-inch distal inner diameters, including the first 2 Vecta 74 cases reported. A literature review on AXS Vecta is also provided. In our series, 9 thrombectomies were performed (Vecta 71: 2 M1, 5 M2 occlusions; Vecta 74: 1 M1 and 1 ICA-terminus occlusion). The AXS Vecta was successfully delivered to the target site in all cases. In 7 of 9 cases, the catheter was delivered over a Tenzing 7 delivery catheter (Route 92 Medical, San Mateo, CA, USA). For 2 of 9 combination approach cases, Vecta was delivered using the stent-retriever wire as a rail. The median improvement in NIHSS score during hospitalization was 9 (IQR 5–12). Successful mTICI 2C or 3 recanalization was achieved in 8 of 9 (89%) patients after a median 2 (IQR 1–2) passes. Our median groin-to-reperfusion time was 23 (IQR 12.5–32) minutes, with no procedural complications. Two previous clinical studies of a total of 29 patients treated with Vecta 71 reported successful mTICI 2b–3 recanalization in 89–90% of cases. The Median groin-to-reperfusion time was 30 minutes. Complications were seen in 2 of 29 (6.9%) cases (vessel perforation and/or intracerebral hemorrhage). These data support the efficacy, deliverability, and safety of AXS Vecta for mechanical thrombectomy.

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Section: Discussionmentioning

confidence: 99%

AXS Vecta 0.071–0.074 Inch Aspiration Catheters for Mechanical Thrombectomy: Case Series and Literature Review

2023

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“…The superior clinical impact of larger bore aspiration catheters has also been suggested in combined aspiration catheter and stent retriever thrombectomy. While cases of primary combined stent retriever and aspiration thrombectomy were not included within the presented analysis, a prior study by Perez-Garcia et al studied 238 patients with a combined technique and found that an ID of 0.068 inch facilitated superior FPE and final recanalization with lower complications compared with 0.06/0.054 inch aspiration catheters 34. This is a relevant consideration given mounting evidence that a combined approach may result in superior FPE compared with direct stent retriever thrombectomy alone 35.…”

Section: Discussionmentioning

confidence: 99%

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

Schartz

Ellens²,

Kohli³

et al. 2022

J NeuroIntervent Surg

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BackgroundDirect aspiration thrombectomy is a well-established method for mechanical thrombectomy in acute ischemic stroke. Yet, the influence of aspiration catheter internal diameter (ID) on aspiration thrombectomy efficacy is incompletely understood.MethodsA systematic literature review and meta-regression analysis was completed to evaluate the impact of primary aspiration thrombectomy outcomes based on the ID of the aspiration catheter. Primary outcome measures were: final recanalization of modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3 with aspiration only and with rescue modalities, first pass effect (FPE), need for rescue modalities, intracranial hemorrhagic complication rates, and functional outcomes of 90-day modified Rankin Scale (mRS) of 0–2.Results30 studies were identified with 3228 patients. Meta-regression analysis revealed a significant association between increasing aspiration catheter ID and FPE (p=0.032), between ID and final recanalization with aspiration only (p=0.05), and between ID size and recanalization including cases with rescue modalities (p=0.002). Further, subgroup analysis indicated that catheters with an ID ≥0.064 inch had a lower rate of need for rescue than smaller catheters (p=0.013). Additionally, catheters with an ID ≥0.068 inch had a higher rate of intracranial bleeding complications (p=0.025). Lastly, no significant association was found in functional outcomes overall.ConclusionsLarger aspiration catheters are associated with a higher rate of FPE, final recanalization with only an aspiration catheter, and in cases with rescue modalities, though with a higher rate of hemorrhagic complications. These findings confirm that aspiration catheter size functions as a variable in aspiration thrombectomy, which should be considered in future study and trial design.

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“… 12 , 13 Additionally, the aspiration catheter size positively correlates with the rate of first-pass effect when used in conjunction with BCG and stent retrieval. 14 However, the IDs of some of the larger BCG systems such as the MERCI 9F (Stryker, Kalamazoo, MI; ID of 0.085 inch) remain smaller than the BMX™ 96 system, raising the issue of compatibility with large-bore catheters. With increasing advances in large-bore aspiration catheters, the need for larger-bore BCGs may be needed.…”

Section: Discussionmentioning

confidence: 99%

Practical use and underlying physics of the BENCHMARK™ BMX™ 96 for large-bore aspiration thrombectomy: Case report of initial institutional experience

et al. 2021

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Endovascular thrombectomy (EVT) is part of first-line intervention for acute ischemic stroke management. Recent technological advances have demonstrated that large-bore catheters are an attractive approach for EVT. A multitude of approaches such as A Direct Aspiration first Pass Technique (ADAPT) or in conjunction with stent retrieval (Solumbra technique) have been developed with increasingly large-bore catheters, demonstrating safety and efficacy. Furthermore, these techniques have demonstrated promise for the intervention of cerebral venous thrombosis as well as posterior circulation ischemic events. Recently, advances in neurointerventional catheters have focused on improved maneuverability to navigate the neurovasculature, as well as larger inner diameters for improved procedural versatility, including aspiration. We describe a case report highlighting our early institutional experience with the recently developed large-bore catheter, the BENCHMARK™ BMX™ 96. The case report entails near complete occlusion of the internal carotid artery from acute thrombus and the utility of the BMX™ 96 catheter for treatment of such extensive clot burden. The applicability of large-bore aspiration catheters, with an emphasis on recent advances, for mechanical thrombectomy in arterial as well as venous systems is discussed. To our knowledge, this is the first reported case of use of the BENCHMARK™ BMX™ 96 access system for EVT in acute ischemic stroke. Such new-generation large-bore catheters are a promising advance in neurointervention, and our early institution experience highlights the ease of use and versatility for neurointerventional procedures such as EVT.

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Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique

Cited by 20 publications

References 31 publications

AXS Vecta 0.071–0.074 Inch Aspiration Catheters for Mechanical Thrombectomy: Case Series and Literature Review

AXS Vecta 0.071–0.074 Inch Aspiration Catheters for Mechanical Thrombectomy: Case Series and Literature Review

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

Practical use and underlying physics of the BENCHMARK™ BMX™ 96 for large-bore aspiration thrombectomy: Case report of initial institutional experience

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