Delivery Assist Catheters: A new Device Class and Initial Experience in Mechanical Thrombectomy in Acute Ischemic Stroke Patients

摘要

Purpose To report in vivo experience of a delivery assist catheter as ascending aid for a large-bore catheter for intracranial thromboaspiration. Methods Retrospective data collection and analysis of stroke databases of two comprehensive stroke centers focusing on technical and angiographic parameters - primary endpoint defined as reaching the occlusion with a large-bore reperfusion catheter - from patients receiving endovascular stroke treatment using an AXS Offset? delivery assist catheter (Stryker, Fremont, CA, USA) between May 2017 and November 2017. Results Using the delivery assist catheter, a 6F catheter could be advanced to an intracranial occlusion for direct thromboaspiration in 30 (88.2%) out of a total of 34 patients (male: n=14 out of 34 [41.2%], age in years: mean [SD]: 75 [11], median baseline NIHSS [National Institutes of Health stroke scale]: 16 [interquartile range, IQR 12-21]). In 4 out of 34 (11.7%) cases the occlusion could not be reached with the aspiration catheter because of a preceding non-occlusive arteriosclerotic plaque (n=1, 2.9%) or because of severe elongation and tortuosity of the arterial access route (n=3, 8.8%). After thromboaspiration mTICI (modified thrombolysis in cerebral infarction) 2b-3 was reached in 14 out of 30 (46.7%) patients. In 21 out of 34 (61.8%) patients stent-retriever-maneuvers (median: 1 [IQR: 0-2]) were needed. In 28 out of 34 (82.3%) patients final mTICI 2b-3 could be achieved. Conclusion Delivery assist catheters can be used as ascending aid for large-bore catheters for thromboaspiration in acute ischemic stroke, in particular to overcome vessel tortuosity and anatomic obstacles.