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  • Aspiration catheter tip flutter is a reliable indicator of successful clot aspiration in ADAPT

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Clinical neurology
Case series
Aspiration catheter tip flutter is a reliable indicator of successful clot aspiration in ADAPT
  1. Dan-Dong Li1,2,
  2. Jing Zheng3,
  3. Ke-Da Pan4,
  4. Pi-Guang Yao5,
  5. Meng-Yao Wang6,
  6. Ren-Hua Duan1,2,
  7. Wei Li1,2,
  8. Shao-Huai Chen1,2,
  9. Bo Yin1,2
    1. 1Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
    2. 2Wenzhou Municipal Key Laboratory of Neurodevelopmental Pathology and Physiology, Wenzhou, China
    3. 3Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, China
    4. 4Department of Neurology, Yongjia County Traditional Chinese Medicine Hospital, Wenzhou, China
    5. 5Department of Neurology, Wenzhou Dongtou People’s Hospital, Wenzhou, China
    6. 6First School of Medicine, Wenzhou Medical University, Wenzhou, China
    1. Correspondence to Dr Bo Yin; 76yinbo{at}163.com

    Abstract

    Background A direct aspiration first pass technique (ADAPT) has emerged as a fast, safe, and efficacious method for treating acute large vessel occlusion. However, successful clot aspiration is not guaranteed in every ADAPT procedure. We have observed that when the catheter effectively ingested the clot, the catheter tip displayed a distinct fluttering motion, referred to herein as tip flutter. Thus this study aimed to assess whether this catheter tip flutter can be used as a sign of successful clot aspiration.

    Methods This retrospective study included 231 consecutive patients admitted to our institution due to acute ischemic stroke and treated with ADAPT between October 2018 and November 2023. We obtained baseline and procedural data from all patients. Additionally, we assessed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the tip flutter in predicting clot aspiration.

    Results The incidence of embolus translocation was significantly higher in the tip flutter positive group than in the tip flutter negative group (P<0.001). Also, hyperdense artery presentation was more prevalent in the positive group (P<0.001), whereas the clot burden score was higher in the negative group (P=0.002). Clot aspiration in the first pass occurred in 83 (96.5%) and 37 (25.5%) patients in the positive and negative groups, respectively (P<0.001). Multivariable logistic regression analysis showed the tip flutter sign (OR 1.09, 95% CI 0.16 to 1.29; P<0.001) was an independent predictor of successful clot aspiration. Sensitivity, specificity, PPV, NPV, and accuracy of the tip flutter for predicting clot aspiration were 69.2%, 97.3%, 96.5 %, 74.5%, and 82.7%, respectively.

    Conclusions In this study, we found that tip flutter was a reliable indicator of successful clot aspiration during ADAPT.

    • Catheter
    • Intervention
    • Stroke
    • Thrombectomy

    https://doi.org/10.1136/jnis-2024-021800

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      Footnotes

      • D-DL and JZ contributed equally.

      • Contributors D-DL: funding acquisition, data curation, formal analysis, and writing (original draft and review). JZ: conceptualization, funding acquisition, data curation, formal analysis, project administration, and writing (review and editing). K-DP: data curation, formal analysis, investigation, software, and writing (review and editing). P-GY: data curation, formal analysis, and software. M-YW: data curation, formal analysis, investigation, and writing (original draft). R-HD: data curation, formal analysis, and software. WL: data curation, formal analysis, and software. S-HC: data curation and investigation. BY: funding acquisition, resources, supervision, and writing (review and editing).

      • Funding This study was supported by the Zhejiang Provincial Natural Science Foundation of China, grant No LY21H090016, to D-DL, by the Science and Technology Program of Wenzhou, China (Y2020438) to JZ and (Y20220119) D-DL, and by the Beijing New Health Industry Development Foundation (XM2020-02-002) to BY.

      • Competing interests None declared.

      • 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.