Abstract 1122‐000101: First‐in‐Human Experience Using the Millipede 088 Aspiration Catheter in Stroke Thrombectomy

Introduction : Studies have suggested that closely matching the catheter size to the vessel size may improve the effectiveness of clot aspiration in stroke thrombectomy. A new category of “super‐bore” aspiration catheters with 8Fr OD and 0.088in ID has recently been developed to further improve reperfusion success. In this work we report on early clinical experience using a CE Marked device called Millipede 088 developed by Perfuze (Galway, Ireland). Methods : The clinical, procedural, and radiological data were reviewed for consecutive cases in which Millipede 088 was used. Millipede 088 was navigated to the target vessel over a 6F intermediate catheter with or without a microcatheter and microwire, at the discretion of the physician. Performance was evaluated in terms of successful intracranial navigation and reperfusion measured using the mTICI scale. Results : Ten patients (age 55–89 years, 50% male) with intracranial large vessel occlusions (LVOs) were treated ‐ 4 ICA and 6 M1 LVOs. In two cases, the patients had concomitant tandem lesions requiring additional treatment. Millipede 088 was delivered intracranially in all cases, and to the target vessel in 8 cases. In two cases in which Millipede 088 was not advanced to the target vessel, it was placed intracranially for distal flow control, and an intermediate catheter was used for clot aspiration. In one case, following mTICI 2b reperfusion after aspiration, a stentriever was deployed via Millipede 088 to retrieve a distal M2 clot. Excellent reperfusion (mTICI 2c‐3) at the end of the procedure, was achieved in all (100%) of patients. First‐pass mTICI 2c‐3 was achieved in 5 patients (50%). No sICH or other complications were reported. Conclusions : In this first in man experience, aspiration thrombectomy using the Millipede 088 proved to be technically feasible and safe. Excellent reperfusion was achieved in all patients. The Millipede 088 represents a promising option for stroke thrombectomy.

Prevention of Paradoxical Cerebral Embolus with Protection System during Combination Right Atrial Clot Aspiration Thrombectomy and Closure of Patent Foramen Ovale

In this technical case report, we describe a 41-year-old female with a history of breast cancer who was found to have a right atrial clot attached to the tip of her Port-A-Cath. During transthoracic echocardiography to evaluate her clot, she was also noted to also have a patent foramen ovale. The decision was made to perform a simultaneous right atrial endovascular aspiration thrombectomy and patent foramen ovale closure. To minimize the risk for paradoxical embolus during clot manipulation, an intravascular embolic neuroprotection device was deployed. After the procedure, it was noted on visual inspection that the device filter contained several embolic fragments. The presence of macroscopic embolic fragments in the filter baskets highlights the role of prophylactic embolic protection when performing cardiac interventions in the setting of a patent foramen ovale, particularly in the presence of a right atrial thrombus or mass.

Republished: First clinical report of aspiration through a novel 0.088-inch catheter positioned in the M1 middle cerebral artery for ELVO thrombectomy

Two patients, separated by 1 year, underwent mechanical thrombectomy using next generation, highly navigable 0.088-inch large bore catheters, which were navigated to and aspirated within the M1 middle cerebral artery segment. Case 1 demonstrates the first reported clinical application of this technique used in conjunction with stent retriever and direct aspiration through an intermediate catheter, resulting in modified thrombolysis in cerebral infarction (mTICI) score 3 recanalisation, and a 90-day modified Rankin Score of 1. In case 2, direct on-clot aspiration was applied through a 0.088-inch guide catheter in the left M1 segment, resulting in mTICI score 3 recanalisation and a National Institutes of Health Stroke Scale score of 1 at discharge. There was no evidence of untoward events in either case. Advancement of a 0.088-inch catheter into the M1 segment offers potential benefits to thrombectomy by improving device-thrombus interaction, inducing local flow arrest and protecting proximal vessels from embolus to new territories.

First clinical report of aspiration through a novel 0.088-inch catheter positioned in the M1 middle cerebral artery for ELVO thrombectomy

Two patients, separated by 1 year, underwent mechanical thrombectomy using next generation, highly navigable 0.088-inch large bore catheters, which were navigated to and aspirated within the M1 middle cerebral artery segment. Case 1 demonstrates the first reported clinical application of this technique used in conjunction with stent retriever and direct aspiration through an intermediate catheter, resulting in modified thrombolysis in cerebral infarction (mTICI) score 3 recanalisation, and a 90-day modified Rankin Score of 1. In case 2, direct on-clot aspiration was applied through a 0.088-inch guide catheter in the left M1 segment, resulting in mTICI score 3 recanalisation and a National Institutes of Health Stroke Scale score of 1 at discharge. There was no evidence of untoward events in either case. Advancement of a 0.088-inch catheter into the M1 segment offers potential benefits to thrombectomy by improving device-thrombus interaction, inducing local flow arrest and protecting proximal vessels from embolus to new territories.

Vessel diameter and catheter-to-vessel ratio affect the success rate of clot aspiration

BackgroundA direct aspiration first pass technique (ADAPT) is an efficient, safe, cost-effective, and fast thrombectomy technique.ObjectiveTo evaluate anatomical and clot characteristics associated with success of the aspiration component as part of ADAPT.Methods106 cases of acute carotid-T, basilar, and middle cerebral artery occlusion undergoing endovascular treatment with ADAPT were retrospectively assessed for successful catheter-clot contact and successful primary aspiration, defined as a Thrombolysis in Cerebral Infarction score ≥2b after primary aspiration with 5F or 6F aspiration catheters. Patient age, National Institutes of Health Stroke Scale (NIHSS) score, time from symptom onset to groin puncture, time from groin puncture to revascularization, aortic arch type, access vessel tortuosity, vessel diameter at the proximal end of the thrombus, catheter-to-vessel ratio (CVR), clot density, length, and perviousness were determined.ResultsSuccessful clot contact with the aspiration catheter was achieved in 76 cases (72%); these patients were younger (67.7±15.2 vs 73.7±11.4 years; p=0.05) and had less tortuous access vessels (1 vs 2 reverse curves; p=0.004) than those in whom clot contact failed. Successful primary aspiration occurred in 36 of these cases (47%) and was associated with significantly smaller vessel diameter at the proximal thrombus end (2.5±0.7 mm vs 3.1±1.3 mm; p=0.01) and higher CVR (CVR outer diameter: 0.85±0.2 vs 0.68±0.2; p=0.01 and CVR inner diameter: 0.72±0.2 vs 0.58±0.2; p<0.001). No significant differences were seen in aortic arch type, radiographic clot features, and NIHSS score.ConclusionWith ADAPT, patient age and vessel tortuosity affect the ability to deliver the aspiration catheter and achieve clot contact, whereas vessel diameter and CVR at the aspiration site seem to affect the effectiveness of clot aspiration. Strategies aimed at improving catheter deliverability and increasing CVR may increase the efficacy of ADAPT.