Tailored Vessel-Catheter Diameter Ratio in a Direct Aspiration First-Pass Technique: Is It a Matter of Caliber?

Pampana, Enrico; Fabiano, Sebastiano; Rubeis, Gianluca De; Bertaccini, Luca; Stasolla, Alessandro; Vallone, Andrea; Pingi, A; Mangiardi, Marilena; Anticoli, Sabrina; Gasperini, Claudio; Cotroneo, Enrico

doi:10.3174/ajnr.a6987

Cited by 10 publications

(2 citation statements)

References 21 publications

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“…This might be related to previously reported factors such as the terminal ICA geometry, the clot extension and shape. However, as demonstrated by Pampana et al, 31 the aspiration catheter should always be selected according to the culprit vessel diameter. In a post hoc direct comparison, CT with DACs <0.070 inches was statistically associated with a lower number of passes and good clinical outcomes at discharge than AT with DACs ≥0.070 inches; there was also a difference in terms of recanalization rate, despite this not being statistically significant (70.3% vs 50.8% of first pass to TICI 2B-3; P=0.142).…”

Section: Discussionmentioning

confidence: 99%

Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience

Diana

Vinci

Ruggiero

et al. 2021

J NeuroIntervent Surg

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BackgroundThere is no consensus on the most effective endovascular technique to use in patients with acute ischemic stroke due to terminal internal carotid artery (ICA) occlusion. The aim of this study was to compare safety and efficacy of the aspiration technique (AT) and combined technique (CT) as first-line approach in terminal ICA occlusions.MethodsWe performed a retrospective analysis of prospectively collected databases from seven Italian stroke centers. Patients were divided into two subgroups according to the first-line approach: AT group or CT group. We followed the STROBE guidelines for cohort studies. We used Chi-square test, one-way and multivariate ANOVA analysis, together with contrast analysis and post hoc tests, logistic regression and Pearson’s bivariate correlation for the statistical analyses.ResultsBetween January 2018 and August 2020, 353 patients were treated for a terminal ICA occlusion, with either AT or CT. CT was associated with a higher Thrombolysis in Cerebral Infarction (TICI) 2B-3 after the first pass (51.0% vs 26.9%) and at the end of the procedure (84% vs 73.3%) and with an improved clinical outcome at discharge (modified Rankin Scale (mRs) 0–2 of 47.8% vs 34.0%) and at 3 months’ follow-up (mRs 0–2 of 56.5% vs 38.9%) compared with AT.ConclusionThrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.

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Section: Discussionmentioning

confidence: 99%

Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience

Diana

Vinci

Ruggiero

et al. 2021

J NeuroIntervent Surg

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show abstract

“…In this regard, larger inner-diameter aspiration catheters capable of complete ingestion of the clot may be the best solution for patients with severely tortuous vascular anatomy. 19 However, despite the in vitro advantages of CA clot retrieval in the tortuous anatomy shown in this experiment, the tortuous anatomy may preclude fast and safe navigation of the aspiration catheter to the occlusion site in real-world patients. Development of more flexible and soft-tipped aspiration catheters with larger inner diameters is warranted.…”

Section: Discussionmentioning

confidence: 86%

In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models

Kim¹,

Kim²,

Kim³

2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Achieving complete recanalization with the front-line endovascular thrombectomy device improves the outcome of acute stroke. The aim of this study was to evaluate whether various thrombectomy techniques including contact aspiration, stent retriever thrombectomy, and combination therapy differ in first-pass effect and distal emboli in acute large-vessel occlusion simulated using 3D printed nontortuous and tortuous cerebrovascular anatomy models.MATERIALS AND METHODS: 3D printed flow models were manufactured using angiographic data of nontortuous and acutely angulated tortuous vascular anatomy from real patients. Three thrombectomy techniques, contact aspiration, stent retriever, and combined methods, were tested under proximal protection with the balloon-guiding catheter. The first-pass effect and distal emboli rates were analyzed in addition to the thrombectomy-failure mechanisms of the respective techniques.RESULTS: A total of 30 thrombectomy experiments were performed. The overall incidence of first-pass effect in the nontortuous and tortuous anatomy was 80.0% versus 46.7%. The overall incidence of distal emboli in the nontortuous and tortuous anatomy was 26.7% versus 46.7%. The contact aspiration technique showed better first-pass effect (80.0%) and distal emboli rates (20%) in the tortuous model compared with other techniques. The combined technique did not show remarkable superiority of the firstpass effect and distal emboli in either the nontortuous or tortuous anatomy. Shearing off of the thrombus was the main mechanism of thrombectomy failure in the combined group. CONCLUSIONS:The tortuous vascular anatomy may worsen the first-pass effect and distal emboli rates. The combined techniques failed to show improvement in outcome due to the shearing-off phenomenon of the thrombus during retrieval.

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Endovascular Detection of Catheter-Thrombus Contact by Vacuum Excitation

Lawson,

Veliky,

Abah

et al. 2024

IEEE Trans. Biomed. Eng.

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Tailored Vessel-Catheter Diameter Ratio in a Direct Aspiration First-Pass Technique: Is It a Matter of Caliber?

Cited by 10 publications

References 21 publications

Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience

Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience

In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models

Endovascular Detection of Catheter-Thrombus Contact by Vacuum Excitation

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