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Abstract
Introduction/Purpose Studies have suggested that closely matching the catheter size to the vessel size may improve effectiveness of clot aspiration in stroke thrombectomy. A new category of Superbore aspiration catheters with 8F OD and 0.088in ID has recently been developed to improve reperfusion success further. Combining 6F and 8F aspiration catheters as a first-line system allows the physician to match the catheter size to the vessel size in real-time. Furthermore, if the vessel is too small to accommodate the 8F catheter, it provides local flow control and distal access for the 6F catheter which is used for aspiration. In this work we report on ‘6/8 Aspiration First’ approach incorporating the Millipede 088 catheter (Perfuze, Galway, Ireland).
Methods In this series, consecutive cases using a 6/8 Aspiration First approach with Millipede 088 and commercially available 6F aspiration catheters (068/070) in ICA, M1, M2 and basilar occlusions are evaluated. In the technique, a 6F aspiration catheter is advanced to the clot with or without a guidewire and microcatheter at the discretion of the physician. Millipede 088 is then navigated over the 6F catheter to the clot, or depending on vessel size and anatomy, as close as possible. Following removal of internal devices, aspiration is applied to retrieve the clot through the 6F or Millipede 088 catheter at the discretion of the physician. If the 6F catheter is used for aspiration and it becomes corked, it is withdrawn into the distally placed Millipede 088. Safety and Performance are evaluated in terms of sICH and the mTICI scale.
Results Nineteen patients with intracranial large vessel occlusions have been treated using this 6F+8F Aspiration First approach; 3 ICA, 15 M1, and 1 M2. First Pass Effect defined as excellent reperfusion mTICI 2c/3 was achieved with 6/8 Aspiration First in 68% (13/19) of cases. Modified First Pass Effect (mTICI 2b/2c/3) was achieved with the technique in 89% (17/19) of cases. In two cases a stentriever was deployed on the first pass to allow crossing of the ophthalmic artery and resulting in mTICI 2b reperfusion. Final reperfusion mTICI 2c-3 and 2b/2c/3 was achieved in 84% (16/19) and 95% (18/19) of cases respectively. No sICH or other complications were reported.
Conclusions A 6/8 Aspiration First technique incorporating Millipede 088 proved to be technically feasible and safe. Further cases will be performed, and the results will be reported at the meeting.
Disclosures D. Fiorella: 4; C; Perfuze. M. Crockett: None. J. Thornton: 4; C; Perfuze. A. Al-Bayati: None. R. Nogueira: 4; C; Perfuze. M. Ribo: None. A. Hassan: None.