Larger ACE 68 aspiration catheter increases first-pass efficacy of ADAPT technique

Almandoz, Josser E Delgado; Kayan, Yasha; Wallace, Adam N.; Tarrel, R; Fease, J; Scholz, J; Milner, A; Roohani, Pezhman; Mulder, Maximilian; Young, Mark

doi:10.1136/neurintsurg-2018-013957

Cited by 61 publications

(41 citation statements)

References 35 publications

(4 reference statements)

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“…First-pass succes for individual catheters ranged from 36.4% to 50%, which did not differ to a level of statistical significance. This is similar to previously published reports using both stentrievers10 and the MAT technique 6. Regardless of the result of the first pass, the overall rate of successful final reperfusion in this cohort is 94.4%.…”

Section: Discussionsupporting

confidence: 90%

“…Delgado Almandoz et al reviewed their experience with the ACE68, ACE64, and ACE60 catheters in a consecutive series of 152 thrombectomies with the ADAPT technique and reported higher rates of successful first-pass reperfusion, shorter reperfusion times, and lower need for stentriever rescue with the larger-bore ACE68 catheter 6. Alawieh et al similarly reported higher rates of recanalization and shorter procedural time in patients treated with larger ACE catheters compared with their earlier generation, smaller catheters 5.…”

Section: Discussionmentioning

confidence: 99%

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Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy

Tonetti

Desai

Casillo

et al. 2019

J NeuroIntervent Surg

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IntroductionVarious large-bore catheters can be employed for manual aspiration thrombectomy (MAT); clinical differences are rarely explored.MethodsProspectively collected demographic, angiographic, and clinical data for patients with acute internal carotid artery, middle cerebral artery M1, or basilar occlusions undergoing MAT over 23 months at a comprehensive stroke center were reviewed. We excluded patients in stentriever-based randomized trials/registries. The four most commonly utilized aspiration catheters were analyzed, and multivariate logistic regression analyses were performed to determine the effect of primary aspiration catheter choice on first-pass success, final reperfusion, and modified Rankin Scale (mRS) score at 90 days.ResultsOf 464 large vessel thrombectomies, 180 were performed via MAT on the first pass with one of four catheters. First-pass success was achieved in 42% of cases overall; this rate did not differ significantly between catheters: 50% for Sofia, 45% for CAT6, 40% for 0.072 inch Navien, and 36% for ACE68, p=0.67. Final Thrombolysis in Cerebral Infarction 2b or 3 reperfusion was achieved in 94% of cases overall: 97% of cases with CAT6, 95% with Sofia, 92% with Navien, and 92% with ACE68, p=0.70. Mean number of passes for index thrombus (2.0 overall), median procedure time (32 min overall), 90-day good outcome (mRS 0–2, mean 36%), and 90-day mortality (mean 27%) did not differ significantly between patients treated with different initial catheters.ConclusionAmong large-bore aspiration catheters, catheter selection is not an independent predictor of first-pass success, final reperfusion, or clinical outcome.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy

Tonetti

Desai

Casillo

et al. 2019

J NeuroIntervent Surg

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“…Studies suggest that the size of the stent retriever21 and the duration of its deployment22 might influence the rate of complete revascularization after one pass. For the CA technique, the size of the aspiration catheter might also be a critical factor 23–26. The choice of the middle cerebral artery branch for device placement may also play an important role 27.…”

Section: Discussionmentioning

confidence: 99%

First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial

Ducroux

Piotin

Gory

et al. 2019

J NeuroIntervent Surg

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BackgroundThe ‘first pass effect’ (FPE), which was originally described with stent retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality.ObjectiveWe report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial.Materials and methodsASTER is a randomized trial comparing angiographic revascularization with the stent retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients.ResultsFPE was achieved in 97/336 patients (28.9%), with no significant difference between SR and CA (respectively 53/169 patients (31.3%) vs 44/167 patients (26.3%), adjusted RR for CA versus SR 0.84, 95% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients.ConclusionIn the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted.Trial registration numberUnique identifier: NCT02523261.

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“…That might be the reason for the relatively low firstpass recanalization rate of 19 % without BGC and 47 % combined with BGC. A study from 2019 showed that larger aspiration catheters increase the first-pass efficacy of the ADAPT technique [25]. No BGC was used and the first-pass recanalization rate was 53 %.…”

Section: Discussionmentioning

confidence: 99%

Choosing an Effective and Safe Direct Aspiration Setup for Tortuous Anatomy in Acute Ischemic Stroke: In vitro Study in a Physiological Flow Model

Madjidyar

Nerkada

Larsen

et al. 2020

Rofo

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Purpose A direct aspiration first pass technique (ADAPT) is an effective thrombectomy option in patients with acute ischemic stroke. Balloon guide catheters (BGC) seem to improve the efficacy of stent retrievers and ADAPT. The last generation 6F aspiration catheters require 9F BGCs, which are rigid devices that are challenging to position in a tortuous anatomy. In this experimental study the efficacy of 6F ADAPT alone and 5F ADAPT combined with 8F BGC was evaluated. Materials and Methods Either a fibrin rich (white) clot or an RBC rich (red) clot was placed in the M1 segment of a transparent silicon phantom. Physiological hemodynamic conditions were maintained. The clots were retrieved by 6F aspiration catheter via 8F long sheath or 5F aspiration catheter via a flexible 8F BGC. Thrombectomy was performed under direct visual control. The primary endpoints were the number of passes and the number of distal emboli. Results Ten experiments were made with each clot model and thrombectomy technique (n = 40). Full recanalization could be achieved in every experiment. First pass mTICI 3 could be achieved by 6F ADAPT in 80 % of red clots and 90 % of white clots. Distal emboli were caused in 10 % and 20 %, respectively. When using 5F ADAPT combined with BGC, a first pass mTICI 3 rate of 90 % in red clots and 100 % in white clots could be achieved. A 10 % rate of distal emboli occurred in both groups. In almost all experiments (both techniques), the thrombi clogged the aspiration catheter. No statistically significant differences could be found between the techniques and clot models. Conclusion 6F ADAPT without BGC was as effective as 5F ADAPT combined with a flexible 8F BGC, with both techniques showing high first-pass recanalization rates and low distal emboli rates. Especially in the case of a tortuous anatomy, these setups should be considered as alternatives to a rigid 9F BGC. The thrombus compositions seemed to be irrelevant in this setting. Key Points: Citation Format

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Larger ACE 68 aspiration catheter increases first-pass efficacy of ADAPT technique

Cited by 61 publications

References 35 publications

Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy

Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy

First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial

Choosing an Effective and Safe Direct Aspiration Setup for Tortuous Anatomy in Acute Ischemic Stroke: In vitro Study in a Physiological Flow Model

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