First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy

Overview

Journal Clin Neuroradiol

Specialties Neurology
Radiology

Date 2023 Mar 1

PMID 36856786

Authors

S Remollo

M Werner

J Blasco

A Lopez-Rueda

L San Roman

E Jimenez-Gomez

I Bravo Rey

P Vega

E Murias

S Rosati

C Perez-Garcia

E Gonzalez

X Manso

S Aixut

O Chirife Chaparro

M Terceno

S Bashir

J M Pumar

E Ruiz-Gonzalez

J C Mendez

Y Aguilar Tejedor

J Zamarro

M Castano

P Daunis-I-Estadella

J Puig

Affiliations

Soon will be listed here.

Abstract

Introduction: Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers.

Methods: We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device.

Results: We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004).

Conclusion: Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.

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References

Zaidat O, Castonguay A, Linfante I, Gupta R, Martin C, Holloway W . First Pass Effect: A New Measure for Stroke Thrombectomy Devices. Stroke. 2018; 49(3):660-666. DOI: 10.1161/STROKEAHA.117.020315. View

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K . 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; 49(3):e46-e110. DOI: 10.1161/STR.0000000000000158. View

Goyal M, Menon B, van Zwam W, Dippel D, Mitchell P, Demchuk A . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387(10029):1723-31. DOI: 10.1016/S0140-6736(16)00163-X. View

Turk 3rd A, Siddiqui A, Fifi J, De Leacy R, Fiorella D, Gu E . Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet. 2019; 393(10175):998-1008. DOI: 10.1016/S0140-6736(19)30297-1. View

Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G . Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER Randomized Clinical Trial. JAMA. 2017; 318(5):443-452. PMC: 5817613. DOI: 10.1001/jama.2017.9644. View

Hsieh K, Chuang K, Weng H, Cheng S, Chiang Y, Chen C . First-Line A Direct Aspiration First-Pass Technique vs. First-Line Stent Retriever for Acute Ischemic Stroke Therapy: A Meta-Analysis. Front Neurol. 2018; 9:801. PMC: 6167481. DOI: 10.3389/fneur.2018.00801. View

Mohlenbruch M, Kabbasch C, Kowoll A, Broussalis E, Sonnberger M, Muller M . Multicenter experience with the new SOFIA Plus catheter as a primary local aspiration catheter for acute stroke thrombectomy. J Neurointerv Surg. 2016; 9(12):1223-1227. DOI: 10.1136/neurintsurg-2016-012812. View

Gross B, Jadhav A, Jovin T, Jankowitz B . Clinical Comparison of New Generation 0.071-inch and 0.072-inch Aspiration Catheters. World Neurosurg. 2019; 130:e463-e466. DOI: 10.1016/j.wneu.2019.06.120. View

Delgado Almandoz J, Kayan Y, Wallace A, Tarrel R, Fease J, Scholz J . Larger ACE 68 aspiration catheter increases first-pass efficacy of ADAPT technique. J Neurointerv Surg. 2018; 11(2):141-146. DOI: 10.1136/neurintsurg-2018-013957. View

10.

Alawieh A, Chatterjee A, Vargas J, Chaudry M, Lena J, Turner R . Lessons Learned Over More than 500 Stroke Thrombectomies Using ADAPT With Increasing Aspiration Catheter Size. Neurosurgery. 2018; 86(1):61-70. DOI: 10.1093/neuros/nyy444. View

11.

Perez-Garcia C, Maegerlein C, Rosati S, Ruther C, Gomez-Escalonilla C, Zimmer C . Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique. Stroke Vasc Neurol. 2021; 6(4):553-560. PMC: 8717769. DOI: 10.1136/svn-2020-000833. View

12.

Jindal G, Serulle Y, Miller T, Le E, Wozniak M, Phipps M . Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters. J Neurointerv Surg. 2016; 9(10):944-947. DOI: 10.1136/neurintsurg-2016-012581. View

13.

Delgado Almandoz J, Kayan Y, Young M, Fease J, Scholz J, Milner A . Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg. 2015; 8(11):1123-1128. DOI: 10.1136/neurintsurg-2015-012122. View

14.

Long T, Kallmes D, Hanel R, Shigematsu T, Halaszyn A, Wolter J . Novel aspiration catheter design for acute stroke thrombectomy. J Neurointerv Surg. 2018; 11(2):190-195. PMC: 6582808. DOI: 10.1136/neurintsurg-2017-013702. View

15.

Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D . Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998; 352(9136):1245-51. DOI: 10.1016/s0140-6736(98)08020-9. View

16.

Haussen D, Rebello L, Nogueira R . Optimizating Clot Retrieval in Acute Stroke: The Push and Fluff Technique for Closed-Cell Stentrievers. Stroke. 2015; 46(10):2838-42. DOI: 10.1161/STROKEAHA.115.010044. View

17.

Schramm P, Navia P, Papa R, Zamarro J, Tomasello A, Weber W . ADAPT technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: results from the PROMISE study. J Neurointerv Surg. 2018; 11(3):226-231. PMC: 6582710. DOI: 10.1136/neurintsurg-2018-014122. View

18.

Nikoubashman O, Nikoubashman A, Busen M, Wiesmann M . Necessary Catheter Diameters for Mechanical Thrombectomy with ADAPT. AJNR Am J Neuroradiol. 2017; 38(12):2277-2281. PMC: 7963740. DOI: 10.3174/ajnr.A5401. View

19.

Humphries W, Hoit D, Doss V, Elijovich L, Frei D, Loy D . Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg. 2014; 7(2):90-4. DOI: 10.1136/neurintsurg-2013-010986. View

20.

Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O . Maximizing First-Pass Complete Reperfusion with SAVE. Clin Neuroradiol. 2017; 28(3):327-338. DOI: 10.1007/s00062-017-0566-z. View