Thrombectomy aspiration post-market study in acute stroke with the Q aspiration catheter: the TAPAS study

Mariano Espinosa de Rueda, Federico Ballenilla Marco, Eñaut Garmendia Lopetegui, Jose M Pumar, Joaquin Zamarro, Blanca García-Villalba, Jose Díaz-Pérez, Antonio Mosqueira, Alex Lüttich, Jose-Angel Larrea, Guillermo Parrilla, Mariano Espinosa de Rueda, Federico Ballenilla Marco, Eñaut Garmendia Lopetegui, Jose M Pumar, Joaquin Zamarro, Blanca García-Villalba, Jose Díaz-Pérez, Antonio Mosqueira, Alex Lüttich, Jose-Angel Larrea, Guillermo Parrilla

Abstract

Background: The Q Aspiration Catheter (MIVI Neuro) has demonstrated greater aspiration flow rates and ingestion forces compared with conventional catheters in vitro. The safety and performance of the Q Catheter was assessed using a direct aspiration first pass technique in patients with acute ischemic stroke at four neurointerventional centers in Spain.

Methods: We included adult patients who underwent mechanical thrombectomy between March 2019 and March 2020 using the Q Catheter as first-line therapy. Performance endpoints included final successful revascularization of the target vessel (defined as modified thrombolysis in cerebral infarction (mTICI) grade 2B/3), first pass revascularization, and overall Q Catheter revascularization. Safety endpoints were symptomatic intracranial hemorrhage (sICH), embolization to new territory (ENT), and procedural complications. Modified Rankin Scale (mRS) score and all-cause mortality were also assessed.

Results: Forty-five subjects were enrolled. The Q Catheter successfully navigated to the lesion in 95.5% (43/45) of patients. Final successful mTICI 2B/3 revascularization was achieved in 93.3% (42/45), first pass mTICI 2B/3 revascularization with the Q Catheter was 55.3% (21/38), and overall with Q Catheter mTICI 2B/3 revascularization was 65.8% (25/38). Favorable clinical outcome of mRS 0-2 was achieved in 55.6% (25/45). There were no cases of ENT. sICH and mortality rates were 2.2% (1/45) and 13.3% (6/45), respectively.

Conclusion: In this multicenter, observational study, the Q Aspiration Catheter used as first-line therapy demonstrated a good and safe profile in terms of navigation, revascularization, and safety in patients with acute ischemic stroke.

Keywords: Catheter; Device; Stroke; Thrombectomy.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

References

    1. Goyal M, Menon BK, van Zwam WH, et al. . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723–31. 10.1016/S0140-6736(16)00163-X
    1. Lapergue B, Blanc R, Gory B, et al. . Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the aster randomized clinical trial. JAMA 2017;318:443–52. 10.1001/jama.2017.9644
    1. Turk AS, Siddiqui A, Fifi JT. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicenter. Lancet 2019;393:998–1008. 10.1016/S0140-6736(19)30297-1
    1. Long TD, Kallmes DF, Hanel R, et al. . Novel aspiration catheter design for acute stroke thrombectomy. J Neurointerv Surg 2019;11:190–5. 10.1136/neurintsurg-2017-013702
    1. Turk AS, Spiotta A, Frei D, et al. . Initial clinical experience with the adapt technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 2014;6:231–7. 10.1136/neurintsurg-2013-010713
    1. Singh J, Wolfe SQ, Janjua RM, et al. . Anchor technique: use of stent retrievers as an anchor to advance thrombectomy catheters in internal carotid artery occlusions. Interv Neuroradiol 2015;21:707–9. 10.1177/1591019915609170
    1. Lin C-M, Wu Y-M, Chang C-H, et al. . The ANTRACK technique: employing a compliant balloon or stent retriever to advance a Large-Bore catheter to an occlusion during thrombectomy procedures in acute stroke patients. Oper Neurosurg 2019;16:692–9. 10.1093/ons/opy202
    1. Hacke W, Kaste M, Fieschi C, et al. . Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). second European-Australasian acute stroke study Investigators. Lancet 1998;352:1245–51. 10.1016/s0140-6736(98)08020-9
    1. Remollo S, Terceño M, Werner M, et al. . Combined Approach to Stroke Thrombectomy Using a Novel Short Flexible Aspiration Catheter with a Stent Retriever : Preliminary Clinical Experience. Clin Neuroradiol 2021. doi:10.1007/s00062-021-01065-7. [Epub ahead of print: 20 Jul 2021].
    1. Möhlenbruch MA, Kabbasch C, Kowoll A, et al. . Multicenter experience with the new Sofia plus catheter as a primary local aspiration catheter for acute stroke thrombectomy. J Neurointerv Surg 2017;9:1223–7. 10.1136/neurintsurg-2016-012812
    1. De Marini P, Nayak S, Zhu F, et al. . A direct aspiration first pass technique with the new Arc catheter for thrombectomy of large vessel occlusion strokes: a multicenter study. Interv Neuroradiol 2019;25:187–93. 10.1177/1591019918803962
    1. Bretzner M, Estrade L, Ferrigno M, et al. . Endovascular stroke therapy with a novel 6-French aspiration catheter. Cardiovasc Intervent Radiol 2019;42:110–5. 10.1007/s00270-018-2093-y
    1. Marnat G, Barreau X, Detraz L, et al. . First-Line Sofia aspiration thrombectomy approach within the endovascular treatment of ischemic stroke multicentric registry: efficacy, safety, and predictive factors of success. AJNR Am J Neuroradiol 2019;40:1006–12. 10.3174/ajnr.A6074
    1. Bilgin C, Durmus Y, Haki C, et al. . Direct aspiration thrombectomy experience with the Sofia 6F catheter in acute ischemic stroke. Jpn J Radiol 2021;39:605–10. 10.1007/s11604-021-01090-z
    1. Schramm P, Navia P, Papa R, et al. . Adapt technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: results from the promise study. J Neurointerv Surg 2019;11:226–31. 10.1136/neurintsurg-2018-014122
    1. Raymond SB, Nasir-Moin M, Koch MJ, et al. . Initial experience with react 68 aspiration catheter. Interv Neuroradiol 2020;26:358–63. 10.1177/1591019919898923
    1. Phan K, Dmytriw AA, Teng I, et al. . A direct aspiration first pass technique vs standard endovascular therapy for acute stroke: a systematic review and meta-analysis. Neurosurgery 2018;83:19–28. 10.1093/neuros/nyx386

Source: PubMed

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