Introduction/Purpose Previous large vessel occlusion (LVO) comparative thrombectomy device trials reported a substantial rate of crossover from first line aspiration thrombectomy (AT) to stent-retriever (SR) thrombectomy. Use of 0.070 inch ‘large-bore’ catheters for AT is associated with increased aspiration flow rates, first pass effect, faster recanalization, reduced procedure time and better reperfusion rates. A 0.070 inch distal inner diameter catheter, FreeClimbTM 70 (Route 92, San Mateo, CA), was recently introduced and comes packaged with a specialized delivery catheter with a tapered distal tip, Tenzing® 7 (Route 92, San Mateo, CA), which significantly reduces the ledge or space between itself and the tip of the access catheter. This is especially important with increased caliber of ‘large bore’ catheters, which have a greater tendency to catch on arterial side branches and encounter increased friction in tortuous vascular anatomy. We report our initial multicenter experience using the FreeClimb 70 delivered over the Tenzing 7 catheter in the treatment of large vessel occlusion stroke.
Materials and Methods After local IRB approval, we retrospectively reviewed and collected the clinical, procedural and imaging data of consecutive patients who underwent off-label AT with the FreeClimb 70 and Tenzing 7 at five institutions. The FreeClimb 70 and Tenzing 7 catheters were inserted as a unit into the guide catheter. After initial selective catheterization of the occluded vessel with Tenzing 7, the FreeClimb 70 was then advanced over the Tenzing catheter to the angiographic limit of contrast on roadmap angiography. The Tenzing was then removed and the FreeClimb 70 catheter was allowed to passively advance into the clot. Vacuum pump aspiration was then applied to the FreeClimb 70 for 2-5 minutes.
Results FreeClimb 70 was successfully delivered over the Tenzing 7 to the target occlusion in 25/25 (100%) of cases (15 M1 segment, 5 M2, 4 ICA-terminus, and 1 basilar artery occlusions). No stent-retrievers were needed for delivery. Median time from groin puncture to first pass was 12 (IQR 8-16) minutes. In 20/25 (80%) cases, a leading microwire was not needed to advance the Tenzing 7 to the target occlusion. First pass effect (mTICI 2C or 3) was achieved in 13/25 (52%). For M1 MCA occlusions, FPE (mTICI 2C or 3) was 9/15 (60%). After a median of 1 (IQR 1-3) pass, successful reperfusion (mTICI ≥ 2B) was achieved in 24/25 (96%) cases, with complete reperfusion (2C or 3) in 22/25 (88%). After the first pass, additional clot retrieval devices were used in 10/25 (40%) cases, including SR in 2/25 (8%) cases. Median groin puncture to reperfusion time was 16 (IQR 12-28) minutes. There were no procedural complications or symptomatic intracranial hemorrhages. NIHSS at discharge decreased on average 8.5 ± 5.5 from presentation. There were three patient deaths: due to respiratory failure, oliguric renal failure, and transition to comfort care for large core infarct.
Conclusions Initial clinical experience supports the use of the FreeClimb 70 catheter with Tenzing 7 for reliable access to intracranial LVO for rapid, effective and safe reperfusion. Further study is warranted.
Disclosures F. Settecase: 2; C; Stryker, Route 92. W. Kim: 2; C; Stryker, Route 92. 4; C; Route 92. J. Kim: None. T. Sivapatham: None. J. Caldwell: None. S. Lee: None. R. Hixon: None. D. Hoss: None. J. English: 2; C; Stryker, Route 92. 4; C; Route 92.
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