Introduction Recent studies have demonstrated that a direct aspiration first pass technique (ADAPT) for the treatment of acute ischemic stroke may be effective and safe. In this study, we sought to optimize the ADAPT technique by incorporating an adjunctive device such as a balloon guide catheter (BGC). The impact of diameter of the aspiration catheter as well as use of BGC on risk of distal embolization and rate of first pass success was evaluated.
Methods Mechanical thrombectomy was simulated in an in-vitro Circle of Willis model. To create a challenging occlusive burden in the MCA, a 20 mm long clot analog was prepared. Direct aspiration was applied via an 0.068 distal access catheter (DAC, Cat 7, Stryker Neurovascular, group: ADAPT068), a large 0.074’ DAC (AXS Vecta 074, Stryker Neurovascular, group: ADAPT074) or 0.068’ DAC with a BGC (FlowGate 2 Balloon Guide Catheter) placed at the cervical ICA (group: ADAPT068-BGC). In both the ADAPT068 and 074 groups, a long 0.091’ sheath was used in conjunction with the DAC. The pump was turned on before the aspiration catheter was advanced proximal to the clot. Each run was assigned a TICI score to assess degree of recanalization. Ten replicates were performed per group, and the maximum thrombectomy attempt was limited to three per run. Distal emboli greater than 200μm were collected and measured using the Coulter Principle.
Results The lowest number of distal emboli was observed when BGC was used in the ADAPT068 group. Collection of visible emboli greater than 1000μm yielded one particle from both the ADAPT068 and ADAPT068-BGC treatment groups, while ADAPT074 followed with four particles (average size 2.25 mm). A total of 34 emboli sized between 200–1000μm were collected from the ADAPT068 group, and the number of emboli was reduced by more than 50% when a BGC was employed in the ADAPT068-BGC group (P>0.05). The highest rate of first pass recanalization was observed in the ADAPT074 treatment group with the largest bore catheter; where 80% of runs scored a TICI 3 after one attempt (see figure 1). Complete ingestion was observed in 90% of cases with the ADAPT074 technique, while the ADAPT068-BGC and ADAPT068 groups achieved rates of 70% and 60% respectively.
Conclusion BGC protected thrombectomy has been shown to reduce distal emboli for stent-retrievers previously. These preliminary data show that BGC protected thrombectomy also imparts benefit for ADAPT. The larger bore aspiration (ADAPT074) achieved the highest rate of first pass recanalization and complete clot ingestion.
Disclosures R. Arslanian: None. M. Marosfoi: 2; C; Stryker Neurovascular, InNeuroCo. Inc., ThrombX. C. Raskett: None. M. J. Gounis: 1; C; Cerenovus, Imperative Care, MIVI Neurosciences, Stryker Neurovascular, National Institute of Health (NIH), US-Israel Binational Science Foundation, Anaconda, Cook Medical, Gentuity, InNeuroCo, Magneto, Microvention, Medtronic Neurovascular, Neuravi, Neurogami, Philips Healthcare, Rapid Medical, Route 92 Medical, Syntheon, Wyss Institute. 2; C; Cerenovus, Imperative Care, MIVI, Phenox, Route 92 Medical, Stryker Neurovascular. 4; C; Imperative Care, Neurogami. A. S. Puri: 1; C; Medtronic Neurovascular, Stryker Neurovascular. 2; C; Medtronic Neurovascular, Stryker Neurovascular. J. Chueh: 2; C; Stryker Neurovascular, InNeuroCo. Inc.
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