Background and objective New large bore aspiration catheters are being used as first line therapy for mechanical thrombectomy in patients with emergent large vessel occlusions. We present the largest combined experience with the new Stryker Neurovascular Vecta 071/074 aspiration catheters. Vecta 074 represents the largest available aspiration catheter in the U.S. We sought to assess the safety, efficacy, direct aspiration first pass success, need for rescue with stent retriever, and clinical improvement.
Methods Multi-institution retrospective review of all Vecta aspiration catheter cases performed at 2 comprehensive stroke centers between January 1, 2019 and March 25, 2019 yielded 26 patients. Key metrics were recorded including pre-procedure ASPECTS score, presenting NIHSS score, last seen normal to groin access, groin access to first device deployment, time to recanalization, revascularization TICI grading, thrombectomy technique (successful direct aspiration, need for rescue stent retriever and number of passes), and outcomes (NIHSS at discharge, rate of symptomatic intracranial hemorrhage sICH, and death prior to discharge).
Results Eighteen 071 and six 074 Vecta aspiration catheters were used (figures.1/2). The average pre-procedure ASPECTS, NIHSS, and time from last seen normal were 8, 17.7, and 5.3 hours, respectively. Time from vascular access to first device delivery was 25.9 minutes. Direct aspiration was attempted as first line technique in all cases and was successful in 72% of cases. 28% of cases required use of a stent retriever to deliver the aspiration catheter (grappling hook technique-figure.3), or for rescue thrombectomy (direct aspiration unsuccessful or to target residual small, distal emboli). TICI 3 revascularization was achieved in 46%, TICI 2C in 23%, TICI 2B in 26%, and 5% with unsuccessful TICI 2A revascularization. The average NIHSS on discharge was 6.1 with two patients expiring prior to discharge (withdrawal of care in two patients with basilar artery occlusion). Complications included one intracranial/extradural non-flow limiting dissection and one sICH. Limitations included: Small sample size, retrospective review, variation in data collection due to differences in institutional records and short time to follow up.
Conclusion Initial experience with the new Stryker Neurovascular Vecta 071/074 aspiration catheters suggests that high TICI 2C/3 reperfusion rates can safely be obtained using direct aspiration in a majority of cases. Stent retrievers can be reserved for cases where grappling hook technique is necessary to deliver the aspiration catheter to the clot or for rescue thrombectomy.
Disclosures S. Satti: 2; C; Stryker Neurovascular, Medtronic Neurovascular, Penumbra Neurovascular, Cerenovus Neurovascular, Terumo. T. Sivapatham: 2; C; Penumbra Neurovascular. E. Almallouhi: None. T. Eden: None. A. Spiotta: 2; C; Minnetronix Neurovascular, Cerenovus Neurovascular, Penumbura Neurovascular.
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