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Initial Experience Using the 5MAX™ ACE Reperfusion Catheter in Intra-arterial Therapy for Acute Ischemic Stroke.

John S, Hussain MS, Toth G, Bain M, Uchino K, Hui FK - J Cerebrovasc Endovasc Neurosurg (2014)

Bottom Line: Average time from groin puncture to successful recanalization was 46 +/- 30 minutes (range 14-98 minutes).There were no procedural complications.The potential for effective and faster recanalization using this device alone or in combination may be a good topic for future study.

View Article: PubMed Central - PubMed

Affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States.

ABSTRACT

Objectives: The 5MAX ACE is a new large bore aspiration catheter available for vessel recanalization for treatment of acute ischemic stroke (AIS). We report our initial experience with its use.

Methods: A retrospective analysis of patients undergoing intra-arterial therapy for AIS using the 5MAX ACE reperfusion catheter at our institution was performed. Patient demographics, clinical characteristics and procedural data were obtained from chart review. Successful recanlization was defined as achievement of Thrombolysis in Cerebral Infarction score (TICI) 2b-3 and time to recanalization was defined as time from groin puncture to achievement of at least TICI 2b recanalization.

Results: The 5MAX ACE was used in 15 patients from July-October 2013. Direct aspiration was used as the primary technique in 10/15 (67%) patients. Out of these, aspiration alone was sufficient for recanalization in 3 (20%) patients. In the remaining 7 (47%) patients, additional devices were used. In 5/15 (33%) patients, combined aspiration/stentriever thrombectomy using Solitaire™ (3/5 patients) and Penumbra 3D Separator™ (2/5 patients) were used as the primary technique. Successful recanlization (TICI 2b-3) was achieved in 11/15 (73%) patients. Average time from groin puncture to successful recanalization was 46 +/- 30 minutes (range 14-98 minutes). There were no procedural complications.

Conclusion: The 5MAX ACE is a useful recanalization tool, either by direct aspiration or combined stentriever/aspiration. It may be most advantageous with large clots in the internal carotid artery. The potential for effective and faster recanalization using this device alone or in combination may be a good topic for future study.

No MeSH data available.


Related in: MedlinePlus

Patient No. 15. Basilar apex is occluded with absence of opacification of bilateral posterior cerebral arteries. First two attempts at direct aspiration were unsuccessful. After the third attempt at direct aspiration, the basilar occlusion was recanalized with establishment of thrombolysis in cerebral infarction score 2b flow.
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Figure 3: Patient No. 15. Basilar apex is occluded with absence of opacification of bilateral posterior cerebral arteries. First two attempts at direct aspiration were unsuccessful. After the third attempt at direct aspiration, the basilar occlusion was recanalized with establishment of thrombolysis in cerebral infarction score 2b flow.

Mentions: The following technique was used for most patients: under road map assistance, the 5MAX ACE was advanced to the face of the clot over a microcatheter (3MAX reperfusion catheter [Penumbra, Inc., Alameda, CA, USA]) and a 0.016 inch microwire (Fathom [Boston Scientific Corp., Naidich, MA, USA]). The wire and the microcatheter were advanced very gently across the clot into a bifurcation branch of the middle cerebral artery (MCA) followed by advancement of the 5MAX ACE. Once the 5MAX ACE was immediately adjacent to the clot, the microcatheter and microwire were removed. Manual suction was applied to the 5MAX ACE using a 0.6 dL syringe. Once a good seal was obtained, the 5MAX ACE catheter was slowly pulled out, maintaining the aspiration. During removal, simultaneous suction to the side port of the guide sheath was applied using a 0.6 dL syringe. Once the 5MAX ACE was removed from the body, the guide sheath was opened to allow back bleeding of possible clots, and then flushed forward once it was confirmed that there were no more clots (Fig. 1). This process using the tri-axial unit was repeated if necessary. Additional devices including stent-retriever, separator with aspiration or direct aspiration through smaller sized catheters (4MAX or 3MAX reperfusion Penumbra catheters) were used for persistent clots or embolization into smaller caliber arteries (Figs. 2 and 3).


Initial Experience Using the 5MAX™ ACE Reperfusion Catheter in Intra-arterial Therapy for Acute Ischemic Stroke.

John S, Hussain MS, Toth G, Bain M, Uchino K, Hui FK - J Cerebrovasc Endovasc Neurosurg (2014)

Patient No. 15. Basilar apex is occluded with absence of opacification of bilateral posterior cerebral arteries. First two attempts at direct aspiration were unsuccessful. After the third attempt at direct aspiration, the basilar occlusion was recanalized with establishment of thrombolysis in cerebral infarction score 2b flow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296047&req=5

Figure 3: Patient No. 15. Basilar apex is occluded with absence of opacification of bilateral posterior cerebral arteries. First two attempts at direct aspiration were unsuccessful. After the third attempt at direct aspiration, the basilar occlusion was recanalized with establishment of thrombolysis in cerebral infarction score 2b flow.
Mentions: The following technique was used for most patients: under road map assistance, the 5MAX ACE was advanced to the face of the clot over a microcatheter (3MAX reperfusion catheter [Penumbra, Inc., Alameda, CA, USA]) and a 0.016 inch microwire (Fathom [Boston Scientific Corp., Naidich, MA, USA]). The wire and the microcatheter were advanced very gently across the clot into a bifurcation branch of the middle cerebral artery (MCA) followed by advancement of the 5MAX ACE. Once the 5MAX ACE was immediately adjacent to the clot, the microcatheter and microwire were removed. Manual suction was applied to the 5MAX ACE using a 0.6 dL syringe. Once a good seal was obtained, the 5MAX ACE catheter was slowly pulled out, maintaining the aspiration. During removal, simultaneous suction to the side port of the guide sheath was applied using a 0.6 dL syringe. Once the 5MAX ACE was removed from the body, the guide sheath was opened to allow back bleeding of possible clots, and then flushed forward once it was confirmed that there were no more clots (Fig. 1). This process using the tri-axial unit was repeated if necessary. Additional devices including stent-retriever, separator with aspiration or direct aspiration through smaller sized catheters (4MAX or 3MAX reperfusion Penumbra catheters) were used for persistent clots or embolization into smaller caliber arteries (Figs. 2 and 3).

Bottom Line: Average time from groin puncture to successful recanalization was 46 +/- 30 minutes (range 14-98 minutes).There were no procedural complications.The potential for effective and faster recanalization using this device alone or in combination may be a good topic for future study.

View Article: PubMed Central - PubMed

Affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States.

ABSTRACT

Objectives: The 5MAX ACE is a new large bore aspiration catheter available for vessel recanalization for treatment of acute ischemic stroke (AIS). We report our initial experience with its use.

Methods: A retrospective analysis of patients undergoing intra-arterial therapy for AIS using the 5MAX ACE reperfusion catheter at our institution was performed. Patient demographics, clinical characteristics and procedural data were obtained from chart review. Successful recanlization was defined as achievement of Thrombolysis in Cerebral Infarction score (TICI) 2b-3 and time to recanalization was defined as time from groin puncture to achievement of at least TICI 2b recanalization.

Results: The 5MAX ACE was used in 15 patients from July-October 2013. Direct aspiration was used as the primary technique in 10/15 (67%) patients. Out of these, aspiration alone was sufficient for recanalization in 3 (20%) patients. In the remaining 7 (47%) patients, additional devices were used. In 5/15 (33%) patients, combined aspiration/stentriever thrombectomy using Solitaire™ (3/5 patients) and Penumbra 3D Separator™ (2/5 patients) were used as the primary technique. Successful recanlization (TICI 2b-3) was achieved in 11/15 (73%) patients. Average time from groin puncture to successful recanalization was 46 +/- 30 minutes (range 14-98 minutes). There were no procedural complications.

Conclusion: The 5MAX ACE is a useful recanalization tool, either by direct aspiration or combined stentriever/aspiration. It may be most advantageous with large clots in the internal carotid artery. The potential for effective and faster recanalization using this device alone or in combination may be a good topic for future study.

No MeSH data available.


Related in: MedlinePlus