Tim W Malisch1, Osama O Zaidat2,3, Alicia C Castonguay2, Franklin A Marden1, Rishi Gupta2,3, Chung-Huan J Sun2,3, Coleman O Martin4, William E Holloway4, Nils Mueller-Kronast5, Joey English6, Italo Linfante7, Guilherme Dabus7, Hormozd Bozorgchami8, Andrew Xavier9, Ansaar T Rai10, Michael Froehler11, Aamir Badruddin12, Thanh N Nguyen13, M Asif Taqi14, Michael G Abraham15, Vallabh Janardhan16, Hashem Shaltoni17, Robin Novakovic18, Albert J Yoo19, Alex Abou-Chebl20, Peng Roc Chen21, Gavin W Britz22, Ritesh Kaushal23, Ashish Nanda24, Raul G Nogueira25. 1. Department of Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA. 2. St Vincent Mercy Hospital, Toledo, Ohio, USA. 3. Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA. 4. Saint Luke's Kansas City, Kansas City, Missouri, USA. 5. Department of Neurology, Delray Medical Center, Delray Beach, Florida, USA. 6. California Pacific Medical Center, San Francisco, California, USA. 7. Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA. 8. Oregon Health and Science University, Portland, Oregon, USA. 9. Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA. 10. Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia, USA. 11. Department of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 12. Provena Saint Joseph Medical Center, Joliet, Illinois, USA. 13. Department of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, Massachusetts, USA. 14. Desert Regional Medical Center, Palm Springs, California, USA. 15. University of Kansas Medical Center, Kansas City, Kansas, USA. 16. Texas Stroke Institute, Plano, Texas, USA. 17. University of Texas Health Science Center, Houston, Texas, USA. 18. Department of Radiology, Neurology, UT Southwestern Medical Center, Dallas, Texas, USA. 19. Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA. 20. Baptist Health System, Louisville, Kentucky, USA. 21. Department of Neurosurgery, University of Texas, Houston, Texas, USA. 22. Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA. 23. Saint Louis University, St. Louis, Missouri, USA. 24. University of Missouri, Columbia, Missouri, USA. 25. Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Abstract
BACKGROUND: Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. SUMMARY: Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC, p = 0.04 and 26% in CGC, p = 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with CGC (54 vs. 91 min, p = 0.001) and was comparable to the BGC time (54 vs. 67, p = 0.11). Final degree of reperfusion was comparable among the groups (TICI [modified Thrombolysis in Cerebral Infarction] score 2b or higher was 72 vs. 70% for CGC vs. 78% for BGC). Procedural complications, mortality, and good clinical outcome at 90 days were similar between the groups. KEY MESSAGES: The ARTS mechanical thrombectomy in acute ischemic stroke patients appears to yield better results as compared to the use of CGCs with no significant difference when compared to BGC. This early ARTS technique NASA registry data are limited by the earlier generation distal large bore catheters and small sample size. Future studies should focus on the comparison of ARTS and BGC techniques.
BACKGROUND: Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. SUMMARY: Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC, p = 0.04 and 26% in CGC, p = 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with CGC (54 vs. 91 min, p = 0.001) and was comparable to the BGC time (54 vs. 67, p = 0.11). Final degree of reperfusion was comparable among the groups (TICI [modified Thrombolysis in Cerebral Infarction] score 2b or higher was 72 vs. 70% for CGC vs. 78% for BGC). Procedural complications, mortality, and good clinical outcome at 90 days were similar between the groups. KEY MESSAGES: The ARTS mechanical thrombectomy in acute ischemic stroke patients appears to yield better results as compared to the use of CGCs with no significant difference when compared to BGC. This early ARTS technique NASA registry data are limited by the earlier generation distal large bore catheters and small sample size. Future studies should focus on the comparison of ARTS and BGC techniques.
Authors: Alejandro M Spiotta; M Imran Chaudry; Ferdinand K Hui; Raymond D Turner; Ryan T Kellogg; Aquilla S Turk Journal: J Neurointerv Surg Date: 2014-01-02 Impact factor: 5.836
Authors: Vitor M Pereira; Jan Gralla; Antoni Davalos; Alain Bonafé; Carlos Castaño; René Chapot; David S Liebeskind; Raul G Nogueira; Marcel Arnold; Roman Sztajzel; Thomas Liebig; Mayank Goyal; Michael Besselmann; Antonio Moreno; Alfredo Moreno; Gerhard Schroth Journal: Stroke Date: 2013-08-01 Impact factor: 7.914
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245