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Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique

BACKGROUND AND PURPOSE: The first-pass effect (FPE), defined as a first-pass Expanded Treatment in Cerebral Ischaemia (eTICI) 2c/3 reperfusion, has emerged as a key metric of efficacy in mechanical thrombectomy (MT) for acute ischaemic stroke. The proximal balloon occlusion together with direct thro...

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Autores principales: Pérez-García, Carlos, Maegerlein, Christian, Rosati, Santiago, Rüther, Charlotte, Gómez-Escalonilla, Carlos, Zimmer, Claus, Arrazola, Juan, Berndt, Maria Teresa, Moreu, Manuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717769/
https://www.ncbi.nlm.nih.gov/pubmed/33782197
http://dx.doi.org/10.1136/svn-2020-000833
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author Pérez-García, Carlos
Maegerlein, Christian
Rosati, Santiago
Rüther, Charlotte
Gómez-Escalonilla, Carlos
Zimmer, Claus
Arrazola, Juan
Berndt, Maria Teresa
Moreu, Manuel
author_facet Pérez-García, Carlos
Maegerlein, Christian
Rosati, Santiago
Rüther, Charlotte
Gómez-Escalonilla, Carlos
Zimmer, Claus
Arrazola, Juan
Berndt, Maria Teresa
Moreu, Manuel
author_sort Pérez-García, Carlos
collection PubMed
description BACKGROUND AND PURPOSE: The first-pass effect (FPE), defined as a first-pass Expanded Treatment in Cerebral Ischaemia (eTICI) 2c/3 reperfusion, has emerged as a key metric of efficacy in mechanical thrombectomy (MT) for acute ischaemic stroke. The proximal balloon occlusion together with direct thrombus aspiration during stent retriever thrombectomy (PROTECT)-PLUS technique consists in the use of a balloon guide catheter and a combined MT approach involving contact aspiration and a stent retriever. The aim of this study is to assess the effectiveness and safety of the PROTECT-PLUS technique using distal aspiration catheters (DACs) with different inner diameters by comparing the large-bore DAC Catalyst 7 versus the use of medium-bore DACs. METHODS: Retrospective analysis of a prospectively maintained database of patients treated with PROTECT-PLUS using Catalyst 7, Catalyst 6 or Catalyst 5 with an occlusion of either the terminal carotid artery or the M1 or M2 segments of the middle cerebral artery from 2018 to 2020 in two comprehensive stroke centres. Baseline characteristics and procedural, safety and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed in order to find independent predictors of FPE. RESULTS: We identified 238 consecutive patients treated with PROTECT-PLUS as front-line approach using Catalyst 7 (n=86), Catalyst 6 (n=78) and Catalyst 5 (n=76). The rate of FPE was higher with Catalyst 7 (54%) than Catalyst 6 (33%, p=0.009) and Catalyst 5 (32%, p=0.005), in addition to higher final eTICI 2c/3 reperfusion rates, shorter procedural times, lower need of rescue therapy and fewer procedure-related complications. After multivariable analysis the sole independent factor associated to FPE was the use of Catalyst 7 (OR 2.34; 95% CI 1.19 to 4.58; p=0.014). CONCLUSION: Further development of combined MT by incorporating larger-bore aspiration catheters is associated with higher reperfusion rates, shorter procedure times, and lower need of rescue therapy while reducing the complication rates.
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spelling pubmed-87177692022-01-12 Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique Pérez-García, Carlos Maegerlein, Christian Rosati, Santiago Rüther, Charlotte Gómez-Escalonilla, Carlos Zimmer, Claus Arrazola, Juan Berndt, Maria Teresa Moreu, Manuel Stroke Vasc Neurol Original Research BACKGROUND AND PURPOSE: The first-pass effect (FPE), defined as a first-pass Expanded Treatment in Cerebral Ischaemia (eTICI) 2c/3 reperfusion, has emerged as a key metric of efficacy in mechanical thrombectomy (MT) for acute ischaemic stroke. The proximal balloon occlusion together with direct thrombus aspiration during stent retriever thrombectomy (PROTECT)-PLUS technique consists in the use of a balloon guide catheter and a combined MT approach involving contact aspiration and a stent retriever. The aim of this study is to assess the effectiveness and safety of the PROTECT-PLUS technique using distal aspiration catheters (DACs) with different inner diameters by comparing the large-bore DAC Catalyst 7 versus the use of medium-bore DACs. METHODS: Retrospective analysis of a prospectively maintained database of patients treated with PROTECT-PLUS using Catalyst 7, Catalyst 6 or Catalyst 5 with an occlusion of either the terminal carotid artery or the M1 or M2 segments of the middle cerebral artery from 2018 to 2020 in two comprehensive stroke centres. Baseline characteristics and procedural, safety and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed in order to find independent predictors of FPE. RESULTS: We identified 238 consecutive patients treated with PROTECT-PLUS as front-line approach using Catalyst 7 (n=86), Catalyst 6 (n=78) and Catalyst 5 (n=76). The rate of FPE was higher with Catalyst 7 (54%) than Catalyst 6 (33%, p=0.009) and Catalyst 5 (32%, p=0.005), in addition to higher final eTICI 2c/3 reperfusion rates, shorter procedural times, lower need of rescue therapy and fewer procedure-related complications. After multivariable analysis the sole independent factor associated to FPE was the use of Catalyst 7 (OR 2.34; 95% CI 1.19 to 4.58; p=0.014). CONCLUSION: Further development of combined MT by incorporating larger-bore aspiration catheters is associated with higher reperfusion rates, shorter procedure times, and lower need of rescue therapy while reducing the complication rates. BMJ Publishing Group 2021-03-29 /pmc/articles/PMC8717769/ /pubmed/33782197 http://dx.doi.org/10.1136/svn-2020-000833 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Pérez-García, Carlos
Maegerlein, Christian
Rosati, Santiago
Rüther, Charlotte
Gómez-Escalonilla, Carlos
Zimmer, Claus
Arrazola, Juan
Berndt, Maria Teresa
Moreu, Manuel
Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique
title Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique
title_full Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique
title_fullStr Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique
title_full_unstemmed Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique
title_short Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique
title_sort impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717769/
https://www.ncbi.nlm.nih.gov/pubmed/33782197
http://dx.doi.org/10.1136/svn-2020-000833
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