Johannes A R Pfaff1, Ralf Siekmann2, Yogesh P Shah3, Peter A Ringleb4, Christian Ulfert1, Kai Koller2, Martin Bendszus1, Markus A Möhlenbruch5. 1. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. 2. Department of Neuroradiology, Klinikum Kassel, Kassel, Germany. 3. Department of Neurology, Klinikum Kassel, Kassel, Germany. 4. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. 5. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. markus.moehlenbruch@med.uni-heidelberg.de.
Abstract
PURPOSE: To report in vivo experience of a delivery assist catheter as ascending aid for a large-bore catheter for intracranial thromboaspiration. METHODS: Retrospective data collection and analysis of stroke databases of two comprehensive stroke centers focusing on technical and angiographic parameters - primary endpoint defined as reaching the occlusion with a large-bore reperfusion catheter - from patients receiving endovascular stroke treatment using an AXS Offset™ delivery assist catheter (Stryker, Fremont, CA, USA) between May 2017 and November 2017. RESULTS: Using the delivery assist catheter, a 6F catheter could be advanced to an intracranial occlusion for direct thromboaspiration in 30 (88.2%) out of a total of 34 patients (male: n = 14 out of 34 [41.2%], age in years: mean [SD]: 75 [11], median baseline NIHSS [National Institutes of Health stroke scale]: 16 [interquartile range, IQR 12-21]). In 4 out of 34 (11.7%) cases the occlusion could not be reached with the aspiration catheter because of a preceding non-occlusive arteriosclerotic plaque (n = 1, 2.9%) or because of severe elongation and tortuosity of the arterial access route (n = 3, 8.8%). After thromboaspiration mTICI (modified thrombolysis in cerebral infarction) 2b‑3 was reached in 14 out of 30 (46.7%) patients. In 21 out of 34 (61.8%) patients stent-retriever-maneuvers (median: 1 [IQR: 0‑2]) were needed. In 28 out of 34 (82.3%) patients final mTICI 2b-3 could be achieved. CONCLUSION: Delivery assist catheters can be used as ascending aid for large-bore catheters for thromboaspiration in acute ischemic stroke, in particular to overcome vessel tortuosity and anatomic obstacles.
PURPOSE: To report in vivo experience of a delivery assist catheter as ascending aid for a large-bore catheter for intracranial thromboaspiration. METHODS: Retrospective data collection and analysis of stroke databases of two comprehensive stroke centers focusing on technical and angiographic parameters - primary endpoint defined as reaching the occlusion with a large-bore reperfusion catheter - from patients receiving endovascular stroke treatment using an AXS Offset™ delivery assist catheter (Stryker, Fremont, CA, USA) between May 2017 and November 2017. RESULTS: Using the delivery assist catheter, a 6F catheter could be advanced to an intracranial occlusion for direct thromboaspiration in 30 (88.2%) out of a total of 34 patients (male: n = 14 out of 34 [41.2%], age in years: mean [SD]: 75 [11], median baseline NIHSS [National Institutes of Health stroke scale]: 16 [interquartile range, IQR 12-21]). In 4 out of 34 (11.7%) cases the occlusion could not be reached with the aspiration catheter because of a preceding non-occlusive arteriosclerotic plaque (n = 1, 2.9%) or because of severe elongation and tortuosity of the arterial access route (n = 3, 8.8%). After thromboaspiration mTICI (modified thrombolysis in cerebral infarction) 2b‑3 was reached in 14 out of 30 (46.7%) patients. In 21 out of 34 (61.8%) patients stent-retriever-maneuvers (median: 1 [IQR: 0‑2]) were needed. In 28 out of 34 (82.3%) patients final mTICI 2b-3 could be achieved. CONCLUSION: Delivery assist catheters can be used as ascending aid for large-bore catheters for thromboaspiration in acute ischemic stroke, in particular to overcome vessel tortuosity and anatomic obstacles.
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