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New devices and techniques
Original research
Super large-bore ingestion of clot (SLIC) leads to high first pass effect in thrombectomy for large vessel occlusion
  1. Francesco Massari1,2,
  2. Guilherme Dabus3,
  3. Gustavo M Cortez4,
  4. Jasmeet Singh1,2,
  5. Anna Luisa Kuhn2,5,
  6. Varun Naragum6,
  7. Vania Anagnostakou7,
  8. Ricardo A Hanel8,
  9. Matthew J Gounis9,
  10. Ajit S Puri2
  1. 1 Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
  2. 2 Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
  3. 3 Department of Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac & Vascular Institute - Baptist Hospital, Miami, Florida, USA
  4. 4 Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA
  5. 5 Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  6. 6 Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
  7. 7 New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  8. 8 Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
  9. 9 Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Ajit S Puri, Department of Neurointerventional Radiology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA; Ajit.Puri{at}umassmemorial.org

Abstract

Background Super large-bore aspiration (SLBA) has shown high rates of complete clot ingestion.

Objective To report the initial clinical feasibility, safety, and efficacy of this novel SLBA insert combination—super large-bore ingestion of clot (SLIC) technique for stroke.

Methods We performed a retrospective review of three comprehensive stroke center databases. The SLIC technique entails a triaxial assembly of an 8 Fr 0.106″ Base Camp catheter, 0.088″ catheter extender (HiPoint), and an insert catheter (Tenzing 8) that completely consumes the inner diameter of the 0.088″ SLBA catheter. The HiPoint catheter is delivered over the Tenzing 8 to the face of the embolus, which is withdrawn, while aspirating through the Base Camp and HiPoint catheters as a single assembly.

Results Thirty-three consecutive patients with large vessel occlusion were treated with SLIC. The median age was 70 years (30–91) and 17 were male (51.5%). The median presenting National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT score was 21 (1–34) and 8 (5–10), respectively. There was 100% success in delivering the 0.088″ catheter to the site of the occlusion. The successful revascularization rate (modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B) was 100% within a single pass in most cases (82%). Final mTICI ≥2C was achieved in 94.1% of occlusions, with 73.5% mTICI 3 recanalization. The rate of first pass effect in achieving excellent reperfusion (mTICI ≥2C) was 70.5%. There were no adverse events or postprocedural symptomatic hemorrhages.

Conclusions Our initial experience with the SLIC technique resulted in achieving a first pass effect (mTICI ≥2C) in 70.5%. Navigation of the SLBA catheter extender over the Tenzing insert was successful and safe in this early experience.

  • Intervention
  • Stroke
  • Technique
  • Catheter

Data availability statement

All data relevant to the study are included in the article. Data sharing not applicable as no datasets generated and/or analysed for this study.

https://doi.org/10.1136/neurintsurg-2022-018806

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    Data availability statement

    All data relevant to the study are included in the article. Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Footnotes

    • Twitter @AjitSPuri1

    • Contributors FM, ASP: responsible for planning, conception, and design of the study, acquisition of data, analysis, interpretation of data, and drafting the manuscript. They are guarantors of the report. GD, GMC, JS, ALK, VN, RAH: responsible for data acquisition, data extraction, quality control, interpretation of data, and critical edits of the manuscript. MJG: conception and design of the study, data interpretation, and drafting the manuscript. All authors approved the final version of this manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. VA, MJG: conception and design of the study, data interpretation, and drafting the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests FM, GMC, JS, ALK, VN, and VA declare no competing interest. GD: Has served as a paid consultant for Medtronic, Penumbra, Stryker, Cerenovus, Microvention, InNeuroCo, Route 92 Medical; has received honoraria for lectures from Medtronic, Penumbra, and Microvention; has served on the Data and Safety Monitoring Board (DSMB) for RIST, and is the treasurer of the Society of Neurointerventional Surgery (SNIS). RAH: Has received resesarch funding from the NIH, Interline Endowment, Microvention, Stryker and CNX; has received consulting fees from Medtronic, Balt, Stryker, Q’Apel, Codman, Cerenovus, Microvention, Imperative Care, Phenox, Rapid Medical; has participated on the DSMB or advisory boards for MICI, eLum, Three Rivers, Shape Medical; and is an investor/stockholder in InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. MJG: Has been a consultant on a fee-per-hour basis for Alembic LLC, Astrocyte Pharmaceuticals, BendIt Technologies, Cerenovus, Imperative Care, Jacob’s Institute, Medtronic Neurovascular, Mivi Neurosciences, phenox GMbH, Q’Apel, Route 92 Medical, Stryker Neurovascular, Wallaby Medical; holds stock in Imperative Care, InNeuroCo, Galaxy Therapeutics, and Neurogami; and has received research support from the National Institutes of Health (NIH), the United States – Israel Binational Science Foundation, Anaconda, ApicBio, Arsenal Medical, Axovant, Balt, Cerenovus, Ceretrieve, CereVasc LLC, Cook Medical, Galaxy Therapeutics, Gentuity, Gilbert Foundation, Imperative Care, InNeuroCo, Insera, Jacob’s Institute, Magneto, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Naglreiter MDDO, Neurogami, Philips Healthcare, Progressive Medical, Pulse Medical, Rapid Medical, Route 92 Medical, Stryker Neurovascular, Syntheon, ThrombX Medical, Wallaby Medical, the Wyss Institute, and Xtract Medical. MJG is associate editor of basic science on the JNIS editorial board. ASP: consultant for Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc, and Arsenal Medical; research grants from NIH, Microvention, Cerenovus, Medtronic Neurovascular, and Stryker Neurovascular; hold stocks in InNeuroCo, Agile, Perfuze, Galaxy and NTI.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.