Thrombectomy aspiration post-market study in acute stroke with the Q aspiration catheter: the TAPAS study

Abstract

BackgroundThe Q Aspiration Catheter (MIVI Neuro) has demonstrated greater aspiration flow rates and ingestion forces compared with conventional catheters in vitro. The safety and performance of the Q Catheter was assessed using a direct aspiration first pass technique in patients with acute ischemic stroke at four neurointerventional centers in Spain.MethodsWe included adult patients who underwent mechanical thrombectomy between March 2019 and March 2020 using the Q Catheter as first-line therapy. Performance endpoints included final successful revascularization of the target vessel (defined as modified thrombolysis in cerebral infarction (mTICI) grade 2B/3), first pass revascularization, and overall Q Catheter revascularization. Safety endpoints were symptomatic intracranial hemorrhage (sICH), embolization to new territory (ENT), and procedural complications. Modified Rankin Scale (mRS) score and all-cause mortality were also assessed.ResultsForty-five subjects were enrolled. The Q Catheter successfully navigated to the lesion in 95.5% (43/45) of patients. Final successful mTICI 2B/3 revascularization was achieved in 93.3% (42/45), first pass mTICI 2B/3 revascularization with the Q Catheter was 55.3% (21/38), and overall with Q Catheter mTICI 2B/3 revascularization was 65.8% (25/38). Favorable clinical outcome of mRS 0–2 was achieved in 55.6% (25/45). There were no cases of ENT. sICH and mortality rates were 2.2% (1/45) and 13.3% (6/45), respectively.ConclusionIn this multicenter, observational study, the Q Aspiration Catheter used as first-line therapy demonstrated a good and safe profile in terms of navigation, revascularization, and safety in patients with acute ischemic stroke.

Mechanical thrombectomy of distal cerebral vessel occlusions of the anterior circulation

“…Nevertheless, recanalization techniques in DMVO seem to be particularly important to improve the recanalization rates, which are still below those in LVO. In this context, the rapid development in recent years of small stent retrievers as well as aspiration catheters with larger aspiration flow rates and ingestion forces must be taken into account 29 .…”

The Stream Device—A Retrospective Review of 51 Cases

“…Over the last decade, there has been a significant improvement in our understanding of the various clot types [6], the interaction between stent-retrievers and clots [7][8][9], and how both stent-retrievers and clots interact with the vessel wall and in combination during retrieval [10]. This improvement in our understanding has led to the development of stent-retrievers with novel designs [11][12][13][14][15], with the synchronous development of novel aspiration catheters [16][17][18] and various techniques for optimising the MT procedure and first-pass recanalisation.…”

In vitro testing of a funnel-tip catheter with different clot types to decrease clot migration in mechanical thrombectomy

“…New endovascular devices, procedures and techniques are being developed to increase the safety and efficacy of mechanical thrombectomy. [19][20][21][22][23] Enhancements to DACs are focused on improving navigability and trackability, greater tip flexibility and proximal stability. 20,22 Aspiration devices are trending towards larger internal luminal diameters.…”

“…While large-bore DACs may also reduce antegrade blood flow and transmit higher aspiration forces compared to standard DACs, they would provide local flow arrest similar to "inflexible" or "fixed" funneled tips used in this study. 23,27 Limitations of inflexible funneled tips can be reduced by using funnels with self-expanding Nitinol meshes, such as our newly developed prototype that has properties similar to a stent retriever and is able to fully expand to the vessel diameter at the target site. Ideally, the cross-sectional contact area between the funnel-shaped tip and thrombus would be maximal.…”