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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 6. Left middle cerebral artery is occluded in the proximal segment with thrombolysis in cerebral infarction (TICI) score 0 flow. After the first attempt at combined stent retriever thrombectomy and aspiration, the LM1 was recanalized, with TICI score 2b flow subsequently established.
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Figure 4: Patient No 6. Left middle cerebral artery is occluded in the proximal segment with thrombolysis in cerebral infarction (TICI) score 0 flow. After the first attempt at combined stent retriever thrombectomy and aspiration, the LM1 was recanalized, with TICI score 2b flow subsequently established.

Mentions: The second technique involving the use of 5MAX ACE was combined aspiration/stentriever thrombectomy using Solitaire™ (ev3/Covidien, Plymouth, MN, USA). After establishing cerebral vascular access as described above, a microcatheter for Solitaire delivery was placed within the 5MAX ACE and advanced to the site of occlusion under road map assistance. The 5MAX ACE was advanced as distally as safely possible. The microwire and microcatheter were advanced through and beyond the thrombus. The microwire was then removed and the stent was deployed over the site of the thrombus. Once satisfactorily deployed, the microcatheter was removed. After 5 minutes, aspiration/stent thrombectomy was performed by pulling the stent into the distal access catheter while applying simultaneous aspiration to the 5MAX ACE using a 0.6 dL syringe. Additional thrombectomy attempts were performed as needed (Fig. 4).


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 6. Left middle cerebral artery is occluded in the proximal segment with thrombolysis in cerebral infarction (TICI) score 0 flow. After the first attempt at combined stent retriever thrombectomy and aspiration, the LM1 was recanalized, with TICI score 2b flow subsequently established.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Patient No 6. Left middle cerebral artery is occluded in the proximal segment with thrombolysis in cerebral infarction (TICI) score 0 flow. After the first attempt at combined stent retriever thrombectomy and aspiration, the LM1 was recanalized, with TICI score 2b flow subsequently established.
Mentions: The second technique involving the use of 5MAX ACE was combined aspiration/stentriever thrombectomy using Solitaire™ (ev3/Covidien, Plymouth, MN, USA). After establishing cerebral vascular access as described above, a microcatheter for Solitaire delivery was placed within the 5MAX ACE and advanced to the site of occlusion under road map assistance. The 5MAX ACE was advanced as distally as safely possible. The microwire and microcatheter were advanced through and beyond the thrombus. The microwire was then removed and the stent was deployed over the site of the thrombus. Once satisfactorily deployed, the microcatheter was removed. After 5 minutes, aspiration/stent thrombectomy was performed by pulling the stent into the distal access catheter while applying simultaneous aspiration to the 5MAX ACE using a 0.6 dL syringe. Additional thrombectomy attempts were performed as needed (Fig. 4).

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