Introduction Mechanical thrombectomy is the treatment of choice for ischemic stroke due to large vessel occlusion. One common reason for failure or prolonged procedure time is vascular touristy inhibiting access to the site of occlusion. A novel device -the TracStar Large Distal Platform (LDP) -may offer improved navigation of tortuous vasculature as well as more distal final positioning when compared to commonly used guide catheters. We investigate the safety and efficacy of the TracStar LDP when used during mechanical thrombectomy.
Methods We perform a multicenter retrospective review of mechanical thrombectomy procedures during which the TracStar LDP was utilized. Procedural information, complications, and key timepoints (groin puncture, clot-first-touch, etc.) were recorded as detailed in the operative note. Vascular tortuosity was assessed via pre-procedural CTA. Distal-most position achieved with TracStar was determined by review of intraprocedural imaging. Linear regression was performed to investigate the potential relationship between vascular tortuosity and procedure time.
Results In a preliminary analysis of 20 cases, successful reperfusion (TICI 2b/3) was achieved in 88% of cases, requiring 1.8 passes on average (rage 1–5). Average NIHSS at presentation was 17.8 ± 6. Anterior circulation emboli were encountered in 15 cases. Average time to clot-first touch was 12± 7 minutes and average time to final reperfusion was 50 ± 27.6 minutes. Good functional outcome (mRS 0–2) at 90 days was achieved in 35% of cases. There was no association between vascular tortuosity and procedure time. There were no procedural complications, and TracStar LDP was exchanged for an alternative guide catheter in two cases due to failure to maintain positing.
Conclusion Mechanical thrombectomy with the Tracstar LDP is safe and effective. Access beyond the horizonal petrous segment of the ICA was achieved in the majority of cases. Interestingly, ICA tortuosity was not associated with an increased time to clot-first-touched. Final analysis of 30 patients in this multi-center retrospective study will be available for presentation at the SNIS Annual Meeting 2020.
Disclosures D. Bageac: None. R. De Leacy: None.
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