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

Abstract

BACKGROUND:We present longitudinal data regarding the outcomes and evolution of mechanical thrombectomy (MT) using a direct aspiration first pass technique. OBJECTIVE: To evaluate the impact of increasing aspiration catheter size. METHODS: This is a planned analysis of a prospective cohort study that enrolled all patients who underwent a direct aspiration first pass technique MT in a comprehensive stroke center from January 2013 to December 2020. We did exploratory analysis of the characteristics and outcomes of patients who had intracranial internal carotid artery or M1 segment of middle cerebral artery occlusion based on the aspiration catheter bore size (small [041, 054, 058, and 060 inch] vs medium [0.064 and 0.068 inch] and medium vs large [0.071, 0.072, and 0.074 inch]). RESULTS: During the 8-year study period, a total of 1004 patients were included. Median age was 69 years, 49% were female patients, and 60.6% were White. Symptomatic hemorrhagic transformation was observed in 47 patients (4.7%), and 366 patients (36.5%) achieved the modified Rankin scale of 0 to 2 at 90 days after the stroke. For patients with intracranial internal carotid artery or M1 occlusion, medium-bore aspiration catheters were more likely to achieve successful recanalization after first aspiration attempt (63.9% vs 51.4%, P = .015) and had a faster groin-to-reperfusion time (16 vs 20 minutes, P = .001) when compared with small-bore catheters. However, these differences were not significant when comparing medium-bore with large-bore catheters. CONCLUSION: Medium-bore catheters had better performance measures compared with small-bore catheters. However, large-bore catheters did not show significantly better performance results that suggest a plateau effect.

Evolution of Transradial Access for Mechanical Thrombectomy—A Single Center Experience

“…When using the ADAPT technique, a plateau effect of aspiration catheter size and efficacy has been reported, with medium-bore aspiration catheters performing and large-bore aspiration catheters. 20 While the effect of aspiration catheters size on the efficacy of combination therapy is less well defined, the strong recanalization rates reported in the present series may echo those seen with ADAPT. Nonetheless, this limitation is important to recognize when implementing TRA for MT.…”

Application of Sofia Plus catheter tip shaping in the treatment of acute middle cerebral artery occlusion: A case control study

“…Medium-diameter aspiration catheters showed higher efficiency of thrombectomy, whereas large-diameter aspiration catheters were difficult to place, thereby increasing the time of thrombectomy. [15] Despite the current improvements in the delivery of aspiration catheters, placing the tip of a large-diameter aspiration catheter to the proximal end of the thrombus remains challenging. This is especially true when the catheter passes through the origin of the ophthalmic artery and the A1 segment at a precarious angle, resulting in failure to smoothly pass the catheter in some patients (Fig.…”

“…Medium-diameter aspiration catheters showed higher efficiency of thrombectomy, whereas large-diameter aspiration catheters were difficult to place, thereby increasing the time of thrombectomy. [ 15 ]…”

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy

“…Gross et al also demonstrated that the Medtronic React 71 (0.071 inch) aspiration catheter, when compared with other 0.068 inch catheters, significantly facilitated FPE defined as TICI 2c-3 in direct aspiration thrombectomy 4. Additionally, a recent study of 506 patients with ICA or M1 occlusions found that medium (0.064–0.068 inch) and large bore (0.071–0.074 inch) aspiration catheters resulted in higher rates of FPE, final recanalization, and faster time to recanalization compared with small bore (0.041–0.06 inch) catheters 33…”