Purpose To report our initial experiences with the new version of the 5Max ACE, the ACE “64”, (Penumbra) in the endovascular management of acute ischemic stroke

Materials and methods Between December 2014–February 2015, 5 patients with acute ischemic stroke were treated with a recently developed, large bore aspiration catheter, the 5Max ACE 64. There were 4 thromboembolic occlusions of the MCA, and one BA. The patients were selected by CT/CTA and CT-perfusion confirming the occlusion of the mentioned arteries, and showing significant perfusion defect, and considerable volume of viable brain tissue - penumbra. All patients were treated under general anesthesia, starting with DSA of the possible sources of collateral arteries, confirming the existing leptomeningeal collaterals followed by DSA of the target artery, confirming the persisting occlusion. After that, a NeuronMax was placed in the ICA or VA, and the ACE 64 was navigated over a Velocity (Penumbra) microcatheter in 2 cases, or a 3Max (Penumbra) microcatheter in 3 cases, to the target lesion. In our experience, the ACE 64 was difficult to navigate through the carotid syphon, especially at the orifice of the ophthalmic artery, over the smaller microcatheter, why we, after the first two cases, followed the company’s recommendation to use the 3Max instead. When direct contact between the thrombus and the ACE 64 was established, confirmed by flow arrest in the ACE, aspiration with the Penumbra pump was started, and maintained either until the thrombus was aspirated through the ACE, or until 5 min. After this time, the ACE was slowly removed, and the patency of the target artery was checked by DSA through the long sheath.

Results The thrombus was removed in all cases at the first attempt, with excellent flow in the target arteries. No complications occurred during the procedures. Four patients showed significant clinical improvement directly after the procedure, the fifth was unchanged, having hemiparesis following a previous stroke.

Conclusion In our experience, this new version of the 5Max is very efficient in the aspiration of the thrombus. Due to its larger lumen, it’s more difficult to navigate over the smaller microcatheters through tortuous segments of the target vessels, especially the ophthalmic region of the ICA. Using the 3Max instead, the navigation gets easy, but it’s very difficult to get a roadmap or perform an angiogram through the ACE, due to the larger OD of the 3Max. Partially retrieving the 3Max, or preparing the roadmap while the 3Max is still in the proximal part of the ACE has solved this issue in our experience.

Disclosures G. Gál: 2; C; Penumbra.