Efficacy of beveled tip aspiration catheter in mechanical thrombectomy for acute ischemic stroke

Abstract

BackgroundDirect aspiration thrombectomy techniques use large bore aspiration catheters for mechanical thrombectomy. Several aspiration catheters are now available. We report a bench top exploration of a novel beveled tip catheter and our experience in treating large vessel occlusions (LVOs) using next-generation aspiration catheters.MethodsA retrospective analysis from a prospectively maintained database comparing the bevel shaped tip aspiration catheter versus non-beveled tip catheters was performed. Patient demographics, periprocedural metrics, and discharge and 90-day modified Rankin Scale (mRS) scores were collected. Patients were divided into two groups based on which aspiration catheter was used.ResultsOur data showed no significant difference in age, gender, IV tissue plasminogen activator administration, admission NIH Stroke Scale score, baseline mRS, or LVO location between the beveled tip and flat tip groups. With the beveled tip, Thrombolysis in Cerebral Infarction (TICI) 2C or better recanalization was more frequent overall (93.2% vs 74.2%, p=0.017), stent retriever usage was lower (9.1% vs 29%, p=0.024), and patients had lower mRS on discharge (median 3 vs 4, p<0.001) and at 90 days (median 2 vs 4, p=0.008).ConclusionPatients who underwent mechanical thrombectomy with the beveled tip catheter had a higher proportion of TICI 2C or better and had a significantly lower mRS score on discharge and at 90 days.

Impact of Increasing Aspiration Catheter Size and Refinement of Technique: Experience of Over 1000 Strokes Treated With ADAPT

“…Many newer, larger-bore aspiration catheters have since been approved including 071, 072, 074 inch and most recently 088 aspiration catheters. 13,15,16,19,20…”

“…Compared with the small-bore aspiration catheters, the mediumbore catheter group had higher NIHSS on admission (18 vs 14, P < .001); otherwise, there was no difference in baseline demographics, ASPECTS, IV tPA, and symptom onset to groin times. There was a higher rate of IA tPA in the small catheter group (22 [14.9%] vs 18 [7.7%], P = .027) while the medium-bore catheters resulted in higher rates of mTICI ≥2C (89 [60.1%] vs 166 [71.2%], P = .025) and mTICI ≥2B after first pass (76 [51.4%] vs 149 [63.9%], P = .015) and shorter groin-to-reperfusion times (20 vs 16 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], P = .001) (Figures 1 and 2). There was no difference in procedural complications or sICH between the 2 groups (P = .185).…”

Case report: Utilization and efficacy of large-bore catheters in mechanical thrombectomies

“…Based on this information, it can possibly be surmised that there may have been a technical error in the way the catheter had been handled during the case, but not because of any defects of the catheter itself. On a different note, it can also be argued that the unique shape of the beveled tip of the catheter may cause complications, such as dissections, but it has been shown by Vargas et al that patients who underwent mechanical thrombectomy with the beveled tip catheter have a higher proportion of TICI 2C or better and a significantly lower mRS score on discharge and at 90 days, though this does not rule out the possibility of dissection ( 10 ). There is also the likelihood of introducing infections into the cerebrovascular system or damaging the vasculature.…”

Mechanical thrombectomy with a novel beveled tip aspiration catheter

“…This case report describes the successful use of a novel beveled tip aspiration catheter, Zoom 71 (Imperative Care, Campbell, CA, USA) in an acute stroke case due to left MCA M2 occlusion. To our knowledge, there is only one study[ 6 ] that evaluated Zoom 71 aspiration catheter. According to the manufacturer, Zoom 71 has an inner diameter of 0.071”, outer diameter of 0.083”, and working length of 137 cm.…”

“…Vargas et al . [ 6 ] proposed that a beveled tip catheter allows for better alignment along the vessel wall and a higher angle of interaction with the thrombus face.…”