Article Text
Abstract
Introduction Advancements over the past decade have established mechanical thrombectomy (MT) as a cornerstone for treating acute ischemic stroke (AIS) in patients with large vessel occlusions (LVO). Emerging evidence suggests the potential clinical benefits and safety of MT for distal medium vessel occlusions (DMVO). Contrary to LVOs however, DMVOs are subject to higher vessel tortuosity, poorer response to intravenous thrombolysis, and potentially greater risk of vessel injury. As such, development and application of more flexible, smaller devices capable of reaching more distal occlusions are necessary. In this study, we conducted a retrospective, single-center investigation on the clinical safety, efficacy, and outcomes associated with the use of the AXS Vecta 46 intermediate catheter for aspiration of both primary and secondary DMVOs in patients who underwent MT for AIS.
Methods We identified all patients with primary and secondary DMVOs who underwent MT using the Vecta 46 catheter. The primary outcome was the rate of successful recanalization (≥TICI 2b). Baseline clinical data, sites of occlusion, the need for rescue therapy with a stent retriever, and any procedural related complications were also documented.
Results Overall, 43 patients underwent MT using the Vecta 46 catheter for aspiration of 54 DMVOs. Our population had a mean age of 70.8 ± 13.8 years, with 27 (62.8%) male and 16 (37.2%) female patients. Cardioembolism (58.1%) was the most common stroke etiology in both groups. Among the 54 DMVOs were 18 (33.3%) primary and 36 (66.7%) secondary DMVOs. Across both groups, the most common target vessel was the M2 (42.6%) followed by the M3 (35.2%). A final TICI score of 2b, 2c, or 3 was achieved in all 100% (18/18) primary DMVOs and in 80.6% (29/36) of secondary DMVOs. FPE was observed in 30 (55.6%) total cases, specifically in 7 (38.9%) primary DMVOs and 23 (63.9%) secondary DMVOs. 8 (44.4%) primary DMVOs and 2 (5.56%) secondary DMVOs required rescue therapy. The median number of passes for primary DMVOs was 2 (IQR: 1–3) and 1 (IQR: 1–1.25) for secondary DMVOs. Among both primary and secondary M2 occlusions, recanalization (TICI 2b/2c/3) was achieved in 22 (95.7%) cases, 12 (52.3%) of which achieved FPE. 6 (26.1%) M2 DMVOs required rescue therapy. A similar recanalization rate was observed across 18 (94.7%) M3 cases. Other target vessels for which the Vecta 46 catheter achieved successful recanalization included the M4, A3, A4, P1, and P2 segments. Recanalization was unsuccessful in one A2 occlusion and one P4 occlusion. Median discharge NIHSS in the primary DMVO group was 6 (IQR: 3.25–17.5) and 8 (IQR: 3–17) in the secondary DMVO group. A median NIHSS shift of -5 (IQR: -14.25 to -0.25) and -5 (IQR: -10 to -2) was observed in the primary and secondary DMVO groups respectively. A total of 6 patients died during their hospitalization. Symptomatic ICH was observed in 3 patients, asymptomatic ICH in 1 patient, and 1 patient had asymptomatic SAH.
Conclusion This study demonstrates the clinical safety and efficacy of the Vecta 46 intermediate catheter for MT of both primary and secondary DMVOs.
Disclosures J. Choi: None. T. Clausen: None. Y. Zhang: None. S. Tsappidi: None. F. Hui: None.