Single-Center Experience Using the 3MAX Reperfusion Catheter for the Treatment of Acute Ischemic Stroke with Distal Arterial Occlusions

Premat, Kévin; Bartolini, Bruno; Baronnet-Chauvet, Flore; Shotar, Eimad; Degos, Vincent; Muresan, Paul; Maria, Federico Di; Gabrieli, Joseph; Rosso, Charlotte; Pistocchi, Silvia; Chiras, J.; Sourour, Nader; Alamowitch, Sonia; Samson, Yves; Clarençon, Frédéric

doi:10.1007/s00062-017-0594-8

Cited by 43 publications

(31 citation statements)

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“…Rescue 3×20 mm Trevo retriever was used in 42% of cases, comparing well with the 31% in the present series. Final successful reperfusion (TICI 2b–3) reached 76% and one vessel perforation occurred 11. Lastly, another study on 18 patients treated with 3MAX for distal occlusions led to final mTICI 2b–3 of 75% 13…”

Section: Discussionmentioning

confidence: 90%

“…While first-pass reperfusion has been associated with less disability,17 we were unable to show a difference in clinical outcome. This presumably relates to the heterogeneity of tissue at-risk eloquence across subjects, variability of volume of tissue at risk, and type of occlusion at presentation (isolated distal occlusion vs distal occlusion in the setting of a concomitant larger vessel/proximal occlusion vs emboli to the same or new territory) 7–13 18. In proximal occlusions, collateral strength has been demonstrated to be inversely associated with NIHSS and directly associated with improved reperfusion rates 19.…”

Section: Discussionmentioning

confidence: 99%

“…Although aspiration and stent retriever mechanical thrombectomy (MT) perform similarly in proximal occlusions, data on more distal occlusions are limited 5 6. The 3×20 mm Trevo Retriever (3 mm Trevo) and the Penumbra 3MAX reperfusion catheter have been reported in distal occlusions with good reperfusion rates and low safety concerns 7–13. However, the optimal approach for distal intracranial occlusions in thrombectomy for AIS is unclear since no comparative data are available.…”

Section: Introductionmentioning

confidence: 99%

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A comparative analysis of 3MAX aspiration versus 3 mm Trevo Retriever for distal occlusion thrombectomy in acute stroke

Haussen

Eby²,

Al‐Bayati

et al. 2019

J NeuroIntervent Surg

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BackgroundAlthough aspiration and stent retriever thrombectomy perform similarly in proximal occlusions, no comparative series are available in distal occlusions. We aimed to compare the 3 mm Trevo Retriever against the 3MAX thromboaspiration catheter in distal arterial occlusions.MethodsA single-center retrospective review of a prospectively maintained databank for patients treated with the 3 mm Trevo stent retriever or 3MAX thromboaspiration as the upfront approach for distal occlusions (middle cerebral artery mid/distal M2/M3, anterior cerebral artery A1/A2/A3 or posterior cerebral artery P1/P2) from January 2014 to July 2018 was performed. The primary outcome was the rate of distal occlusion first-pass reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b–3).ResultsOf 1100 patients treated within the study period, 137 patients/144 different arteries were treated with the 3 mm Trevo (n=92) or 3MAX device (n=52). The groups had comparable demographics and baseline characteristics. There was a higher rate of first-pass mTICI 2b–3 reperfusion (62% vs 44%; p=0.03), a trend towards a higher rate of final mTICI 2b–3 reperfusion (84% vs 69%; p=0.05), and lower use of adjuvant therapy (15% vs 31%; p=0.03) with the 3 mm Trevo compared with the 3MAX. The median number of passes (p=0.46), frequency of arterial spasm (p=1.00), rates of parenchymal hematomas (p=0.22)/subarachnoid hemorrhage (p=0.37) in the territory of the approached vessel were similar across the two groups. The 90-day rate of good outcomes (45% vs 46% in the 3 mm Trevo and 3MAX groups, respectively; p=0.84) was comparable. Multivariable regression identified baseline NIH Stroke Scale (NIHSS) score (OR 0.9; 95% CI 0.8 to 0.97; p<0.01) and use of 3 mm Trevo (OR 2.2; 95% CI 1.1 to 4.6; p=0.02) independently associated with first-pass mTICI 2b–3 reperfusion.ConclusionsIn the setting of distal arterial occlusions, the 3 mm Trevo may lead to higher rates of first-pass reperfusion than direct 3MAX thromboaspiration. Lower NIHSS was found to be associated with improved reperfusion rates as observed in more proximal lesions. Further studies are warranted.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A comparative analysis of 3MAX aspiration versus 3 mm Trevo Retriever for distal occlusion thrombectomy in acute stroke

Haussen

Eby²,

Al‐Bayati

et al. 2019

J NeuroIntervent Surg

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“…To this purpose, we merged two large acute stroke datasets (ASTER trial9 and Pitié-Salpêtrière registry10) of patients treated by endovascular therapy (EVT) for a large vessel occlusion in the anterior circulation and who had MRI at day 1, when the final extent of the infarct was reached. Our hypothesis was that critical regions associated with 3-month good outcome would differ between the left and right hemisphere, especially at the cortical level where the specificity of the dominant and non-dominant hemispheres are more marked.…”

Section: Introductionmentioning

confidence: 99%

Impact of infarct location on functional outcome following endovascular therapy for stroke

Rosso

Blanc

et al. 2018

J Neurol Neurosurg Psychiatry

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ObjectivesThe relationship between stroke topography (ie, the regions damaged by the infarct) and functional outcome can aid clinicians in their decision-making at the acute and later stages. However, the side (left or right) of the stroke may also influence the identification of clinically relevant regions. We sought to determine which brain regions are associated with good functional outcome at 3 months in patients with left-sided and right-sided stroke treated by endovascular treatment using the diffusion-weighted imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS).MethodsPatients with ischaemic stroke (n = 405) were included from the ASTER trial and Pitié-Salpêtrière registry. Blinded readers rated ASPECTS on day 1 DWI. Stepwise logistic regression analyses were performed to identify the regions related to 3-month outcome in left (n = 190) and right (n = 215) sided strokes with the modified Rankin scale (0–2) as a binary independent variable and with the 10 regions-of-interest of the DWI-ASPECTS as independent variables.ResultsMedian National Institute of Health Stroke Scale (NIHSS) at baseline was 17 (IQR: 12–20), median age was 70 years (IQR: 58–80) and median day-one NIHSS 9 (IQR: 4–18). Not all brain regions have the same weight in predicting good outcome at 3 months; moreover, these regions depend on the affected hemisphere. In left-sided strokes, the multivariate analysis revealed that preservation of the caudate nucleus, the internal capsule and the cortical M5 region were independent predictors of good outcome. In right-sided strokes, the cortical M3 and M6 regions were found to be clinically relevant.ConclusionCortical non-motors areas related to outcome differed between left-sided and right-sided strokes. This difference might reflect the specialisation of the dominant and non-dominant hemispheres for language and attention, respectively. These results may influence decision-making at the acute and later stages.Trial registration number NCT02523261.

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“…9,13,15 Our center's experience with distal artery occlusions treated by endovascular means shows a recanalization rate of 76%. 20 Third, we would like to report our disagreement with the MCA segmentation used in this paper. Indeed, the MCA segmentation commonly used is the one described in 1938 by Fischer 21 (Fig 1) and further used in anatomic 22 and angiographic 23 Our translation of this article reports that: "The course of the middle cerebral artery is decomposed in the following subsections:…”

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confidence: 99%

Caution; Confusion Ahead…

Capocci

Shotar

Sourour

et al. 2017

AJNR Am J Neuroradiol

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Single-Center Experience Using the 3MAX Reperfusion Catheter for the Treatment of Acute Ischemic Stroke with Distal Arterial Occlusions

Abstract: 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.

Cited by 43 publications

References 32 publications

A comparative analysis of 3MAX aspiration versus 3 mm Trevo Retriever for distal occlusion thrombectomy in acute stroke

A comparative analysis of 3MAX aspiration versus 3 mm Trevo Retriever for distal occlusion thrombectomy in acute stroke

Impact of infarct location on functional outcome following endovascular therapy for stroke

Caution; Confusion Ahead…

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