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Ischemic Stroke
Case series
Large-bore aspiration catheter selection does not influence reperfusion or outcome after manual aspiration thrombectomy
  1. Daniel A Tonetti1,2,
  2. Shashvat M Desai2,3,
  3. Stephanie Casillo1,
  4. Benjamin M Zussman1,2,
  5. Merritt W Brown2,3,
  6. Ashutosh P Jadhav2,3,
  7. Brian Thomas Jankowitz1,2,
  8. Tudor G Jovin2,3,
  9. Bradley A Gross1,2
  1. 1 Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2 The Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  3. 3 Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Bradley A Gross, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; grossb2{at}upmc.edu

Abstract

Introduction Various large-bore catheters can be employed for manual aspiration thrombectomy (MAT); clinical differences are rarely explored.

Methods Prospectively collected demographic, angiographic, and clinical data for patients with acute internal carotid artery, middle cerebral artery M1, or basilar occlusions undergoing MAT over 23 months at a comprehensive stroke center were reviewed. We excluded patients in stentriever-based randomized trials/registries. The four most commonly utilized aspiration catheters were analyzed, and multivariate logistic regression analyses were performed to determine the effect of primary aspiration catheter choice on first-pass success, final reperfusion, and modified Rankin Scale (mRS) score at 90 days.

Results Of 464 large vessel thrombectomies, 180 were performed via MAT on the first pass with one of four catheters. First-pass success was achieved in 42% of cases overall; this rate did not differ significantly between catheters: 50% for Sofia, 45% for CAT6, 40% for 0.072 inch Navien, and 36% for ACE68, p=0.67. Final Thrombolysis in Cerebral Infarction 2b or 3 reperfusion was achieved in 94% of cases overall: 97% of cases with CAT6, 95% with Sofia, 92% with Navien, and 92% with ACE68, p=0.70. Mean number of passes for index thrombus (2.0 overall), median procedure time (32 min overall), 90-day good outcome (mRS 0–2, mean 36%), and 90-day mortality (mean 27%) did not differ significantly between patients treated with different initial catheters.

Conclusion Among large-bore aspiration catheters, catheter selection is not an independent predictor of first-pass success, final reperfusion, or clinical outcome.

  • stroke
  • thrombectomy
  • catheter

https://doi.org/10.1136/neurintsurg-2018-014633

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    Footnotes

    • Contributors Conception/design: BAG, APJ, TGJ. Drafting the article: DAT, BAG. Acquisition of data/analysis: DAT, SMD, SC. Reviewed and revised prior to submission: All authors. Study supervision: BAG, APJ, TGJ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests BTJ: Consultant: Medtronic. MWB: Investor: Penumbra. BAG: Consultant: Microvention. TGJ: Consultant: Stryker Neurovascular (PI DAWN-unpaid); Ownership Interest: Anaconda; Advisory Board/Investor: FreeOx Biotech, Advisory Board/Investor: Route92; Advisory Board/Investor: Blockade Medical, Consultant; Honoraria: Cerenovus.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.