Efficacy and Safety of a New Delivery Assist Catheter with a Flexible, Spindle-shaped Shaft, in Mechanical Thrombectomy

Sho Takeshita; Kouhei Nii; Jun Tsugawa; Ayako Ishii; Hironori Fukumoto; Hayatsura Hanada; Ritsurou Inoue; Kimiya Sakamoto; Toshio Higashi

doi:10.1016/j.wneu.2024.05.025

Efficacy and Safety of a New Delivery Assist Catheter with a Flexible, Spindle-shaped Shaft, in Mechanical Thrombectomy

World Neurosurg. 2024 May 10:S1878-8750(24)00779-4. doi: 10.1016/j.wneu.2024.05.025. Online ahead of print.

Authors

Sho Takeshita¹, Kouhei Nii², Jun Tsugawa³, Ayako Ishii¹, Hironori Fukumoto⁴, Hayatsura Hanada⁵, Ritsurou Inoue⁶, Kimiya Sakamoto⁶, Toshio Higashi⁷

Affiliations

¹ Department of Neurology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
² Stroke Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan;; Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Fukuoka, Japan;. Electronic address: k.nii@cis.fukuoka-u.ac.jp.
³ Department of Neurology, Fukuoka University Chikushi Hospital, Fukuoka, Japan;; Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Fukuoka, Japan.
⁴ Department of Neurosurgery, Fukuoka University, Fukuoka, Japan.
⁵ Stroke Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan;; Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Fukuoka, Japan.
⁶ Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
⁷ Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Fukuoka, Japan;; Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.

PMID: 38735560
DOI: 10.1016/j.wneu.2024.05.025

Abstract

Objectives: Large-bore aspiration catheters (AC) are used successfully in mechanical thrombectomy (MT). However, tortuous access routes prevent device navigation because of the ledge effect. The AXS Offset™ Delivery Assist Catheter is designed to reduce the ledge effect. The purpose of this study was to evaluate whether the Offset™ affects AC navigation compared with standard inner microcatheters in MT.

Materials and methods: We retrospectively investigated 75 MTs for anterior circulation occlusion between January 2018 and May 2022 at our hospital. All MTs were performed using an AC, and two types of inner microcatheter (Offset™ or 0.021-0.027-inch standard microcatheter) were chosen randomly during AC navigation. The patients' characteristics, MT techniques, angiographic findings, and clinical outcomes were compared between the Offset and standard group (Non-Offset). The puncture to first pass of the lesion (PTFP) time was investigated to compare the characteristics of the inner catheters.

Results: The Offset group comprised 12 patients vs 63 in the Non-Offset group. Although most baseline clinical characteristics and outcomes were similar between the groups, the PTFP time was significantly shorter in the Offset vs Non-Offset group (31 ± 10 vs 46 ± 24 min, respectively; p = 0.032). In the Offset group, all stent retrievers were deployed via the Offset. One artery dissection and eight symptomatic intracranial hemorrhages occurred in the Non-Offset group; no complications occurred in the Offset group.

Conclusions: The AXS Offset™ delivery assist catheter permitted faster and safer navigation of various ACs to the occlusions compared with standard delivery microcatheters in MT.

Keywords: AXS Offset™ Delivery Assist Catheter; Endovascular procedure; Large vessel occlusion; Large-bore aspiration catheter; Mechanical thrombectomy; Navigation.