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Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience

OBJECTIVE: Early successful reperfusion is associated with favorable outcomes in acute ischemic stroke (AIS). The purpose of this study was to achieve successful recanalization by a combined mechanical thrombectomy technique, the Aspiration-Retriever Technique for Stroke (ARTS), which is composed of...

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Autores principales: Nam, Ji Won, Jung, Na Young, Park, Eun Suk, Kwon, Soon Chan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurosurgical Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435647/
https://www.ncbi.nlm.nih.gov/pubmed/34503313
http://dx.doi.org/10.3340/jkns.2020.0308
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author Nam, Ji Won
Jung, Na Young
Park, Eun Suk
Kwon, Soon Chan
author_facet Nam, Ji Won
Jung, Na Young
Park, Eun Suk
Kwon, Soon Chan
author_sort Nam, Ji Won
collection PubMed
description OBJECTIVE: Early successful reperfusion is associated with favorable outcomes in acute ischemic stroke (AIS). The purpose of this study was to achieve successful recanalization by a combined mechanical thrombectomy technique, the Aspiration-Retriever Technique for Stroke (ARTS), which is composed of a flexible large lumen distal access catheter and a retrievable stent as the first-line strategy of mechanical thrombectomy. METHODS: We retrospectively reviewed 62 patients with AIS who underwent mechanical thrombectomy from 2018 to 2019 at our institute by a senior neurointerventionalist. Among them, patients who were treated using the ARTS technique with the soft torqueable catheter optimized for intracranial access (SOFIA(®); MicroVention-Terumo, Tustin, CA, USA) as the first-line treatment were included. Patients who had tandem occlusions or underlying intracranial artery stenosis were excluded. The angiographic and clinical outcomes were evaluated. The angiographic outcome was analyzed by the rate of successful recanalization, defined as a Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all procedures and the rate of successfully achieving the first pass effect (FPE), defined as complete recanalization with a single pass of the device. The clinical outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), and mortality. RESULTS: A total of 27 patients (mean age, 59.3 years) fulfilled the inclusion criteria. The successful recanalization rate was 96% (n=26) while the FPE rate was 41% (n=11). The mean post-procedural NIHSS change was -3.0. Thirteen patients (48%) showed good clinical outcomes after thrombectomy with the ARTS technique (mRS at 90 days ≤2). Postoperative complications occurred in seven of 25 patients : hemorrhagic transformation in six patients (22%) and distal embolization in one patient (4%). Mortality was 15% (n=4). CONCLUSION: Although the clinical outcomes using the ARTS technique with a flexible large lumen distal access catheter performed as the frontline thrombectomy in patients with AIS were not significantly superior than those of other studies, this study showed a high rate of successful endovascular recanalization which was comparable to that of other studies. Therefore, ARTS using the SOFIA(®) catheter can be considered as the first choice of treatment for AIS due to large vessel occlusion.
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spelling pubmed-84356472021-09-20 Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience Nam, Ji Won Jung, Na Young Park, Eun Suk Kwon, Soon Chan J Korean Neurosurg Soc Clinical Article OBJECTIVE: Early successful reperfusion is associated with favorable outcomes in acute ischemic stroke (AIS). The purpose of this study was to achieve successful recanalization by a combined mechanical thrombectomy technique, the Aspiration-Retriever Technique for Stroke (ARTS), which is composed of a flexible large lumen distal access catheter and a retrievable stent as the first-line strategy of mechanical thrombectomy. METHODS: We retrospectively reviewed 62 patients with AIS who underwent mechanical thrombectomy from 2018 to 2019 at our institute by a senior neurointerventionalist. Among them, patients who were treated using the ARTS technique with the soft torqueable catheter optimized for intracranial access (SOFIA(®); MicroVention-Terumo, Tustin, CA, USA) as the first-line treatment were included. Patients who had tandem occlusions or underlying intracranial artery stenosis were excluded. The angiographic and clinical outcomes were evaluated. The angiographic outcome was analyzed by the rate of successful recanalization, defined as a Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all procedures and the rate of successfully achieving the first pass effect (FPE), defined as complete recanalization with a single pass of the device. The clinical outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), and mortality. RESULTS: A total of 27 patients (mean age, 59.3 years) fulfilled the inclusion criteria. The successful recanalization rate was 96% (n=26) while the FPE rate was 41% (n=11). The mean post-procedural NIHSS change was -3.0. Thirteen patients (48%) showed good clinical outcomes after thrombectomy with the ARTS technique (mRS at 90 days ≤2). Postoperative complications occurred in seven of 25 patients : hemorrhagic transformation in six patients (22%) and distal embolization in one patient (4%). Mortality was 15% (n=4). CONCLUSION: Although the clinical outcomes using the ARTS technique with a flexible large lumen distal access catheter performed as the frontline thrombectomy in patients with AIS were not significantly superior than those of other studies, this study showed a high rate of successful endovascular recanalization which was comparable to that of other studies. Therefore, ARTS using the SOFIA(®) catheter can be considered as the first choice of treatment for AIS due to large vessel occlusion. Korean Neurosurgical Society 2021-09 2021-09-01 /pmc/articles/PMC8435647/ /pubmed/34503313 http://dx.doi.org/10.3340/jkns.2020.0308 Text en Copyright © 2021 The Korean Neurosurgical Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Article
Nam, Ji Won
Jung, Na Young
Park, Eun Suk
Kwon, Soon Chan
Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience
title Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience
title_full Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience
title_fullStr Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience
title_full_unstemmed Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience
title_short Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience
title_sort aspiration-retriever technique for stroke with large bore intermediate catheter : a single center experience
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435647/
https://www.ncbi.nlm.nih.gov/pubmed/34503313
http://dx.doi.org/10.3340/jkns.2020.0308
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