Kévin Premat1, Bruno Bartolini1, Flore Baronnet-Chauvet2,3, Eimad Shotar1, Vincent Degos3,4, Paul Muresan5, Federico Di Maria6, Joseph Gabrieli1,3, Charlotte Rosso2,3, Silvia Pistocchi1, Jacques Chiras1,3, Nader Sourour1, Sonia Alamowitch3,5, Yves Samson2,3, Frédéric Clarençon7,8. 1. Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 2. Department of Vascular Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France. 3. UPMC Univ Paris-06, Sorbonne Universités, Paris, France. 4. Department of Neuro-Intensive Care, Pitié-Salpêtrière Hospital, AP-HP, Paris, France. 5. Department of Vascular Neurology, Saint-Antoine Hospital, AP-HP, Paris, France. 6. Department of Interventional Neuroradiology, Foch hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France. 7. Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. fredclare5@gmail.com. 8. UPMC Univ Paris-06, Sorbonne Universités, Paris, France. fredclare5@gmail.com.
Abstract
PURPOSE: Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3.8 F) reperfusion catheter for the recanalization of distal intracranial arteries. METHODS: From August 2015 to December 2016, 32 consecutive patients (16 females, 50%; mean age = 67.4 ± 18.7 years, range: 22-91) for 38 distal occlusions underwent mechanical thrombectomy (MT) by thromboaspiration using the 3MAX. Median NIHSS score at admission was 14 (IQR: 9-19). Distal occlusions were distributed as follows: M2 (n: 23), M3 (n: 6), P1 (n: 3), P2 (n: 2), P3 (n: 2), A3 segment (n: 1) and superior cerebellar artery (n: 1). RESULTS: In 1/38 (2.6%) target artery, the 3MAX could not be navigated. Of the 37 (59.5%) remaining arteries, 22 were successfully reperfused (TICI 2b/3) after ADAPT with the 3MAX alone. Additional stent retriever thrombectomy allowed a 76.3% final reperfusion rate. Good functional outcome (mRS ≤2) was obtained in 45.5% of patients at 3 months. Three (9.4%) 3MAX-related complications occurred: 2 emboli to new territory (ENT) and one vascular perforation. CONCLUSIONS: The 3MAX is well-navigable in distal arteries making it useful as a frontline technique. However, the reperfusion rate with the 3MAX catheter alone seems lower than the ones reported with stent retrievers for such distal occlusions.
PURPOSE: Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3.8 F) reperfusion catheter for the recanalization of distal intracranial arteries. METHODS: From August 2015 to December 2016, 32 consecutive patients (16 females, 50%; mean age = 67.4 ± 18.7 years, range: 22-91) for 38 distal occlusions underwent mechanical thrombectomy (MT) by thromboaspiration using the 3MAX. Median NIHSS score at admission was 14 (IQR: 9-19). Distal occlusions were distributed as follows: M2 (n: 23), M3 (n: 6), P1 (n: 3), P2 (n: 2), P3 (n: 2), A3 segment (n: 1) and superior cerebellar artery (n: 1). RESULTS: In 1/38 (2.6%) target artery, the 3MAX could not be navigated. Of the 37 (59.5%) remaining arteries, 22 were successfully reperfused (TICI 2b/3) after ADAPT with the 3MAX alone. Additional stent retriever thrombectomy allowed a 76.3% final reperfusion rate. Good functional outcome (mRS ≤2) was obtained in 45.5% of patients at 3 months. Three (9.4%) 3MAX-related complications occurred: 2 emboli to new territory (ENT) and one vascular perforation. CONCLUSIONS: The 3MAX is well-navigable in distal arteries making it useful as a frontline technique. However, the reperfusion rate with the 3MAX catheter alone seems lower than the ones reported with stent retrievers for such distal occlusions.
Entities:
Keywords:
A direct aspiration first-pass thrombectomy; Distal occlusion; Endovascular procedures; Mechanical thrombectomy; Stroke
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