The novel Tenzing 7 delivery catheter designed to deliver intermediate catheters to the face of embolus without crossing: clinical performance predicted in anatomically challenging model

被引：19

作者：

Froelich, Andreas Maximilian ^{[1
]}

Kim, Warren ^{[2
]}

Stribrny, Knut ^{[1
]}

Jansen, Olav ^{[3
]}

Moehlenbruch, Markus ^{[4
]}

Szikora, Istvan ^{[5
]}

Wodarg, Fritz ^{[6
]}

Fiehler, Jens ^{[7
]}

Otto, Kim ^{[8
]}

Chou, Tony ^{[8
]}

Buhk, Jan Hendrik ^{[1
]}

English, Joey ^{[2
]}

机构：

[1] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, D-20246 Hamburg, Germany

[2] Calif Pacific Med Ctr, Radiol, San Francisco, CA USA

[3] Univ Med Ctr Schleswig Holstein, Dept Radiol & Neuroradiol, Campus Kiel, Kiel, Schleswig Holst, Germany

[4] Univ Hosp Heidelberg, Neuroradiol, Heidelberg, Baden Wurttembe, Germany

[5] Natl Inst Neurosci, Neurointervent, Budapest, Hungary

[6] Univ Klinikum Schleswig Holstein, Dept Radiol & Neuroradiol, Campus Kiel, Kiel, Germany

[7] Univ Med Ctr Hamburg Eppendorf, Dept Neuroradiol, Hamburg, Germany

[8] Route 92 Med Inc, San Mateo, CA USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2021年 / 13卷 / 08期

关键词：

catheter; guidewire; stroke; thrombectomy; intervention; STENT-RETRIEVER THROMBECTOMY; LARGE VESSEL OCCLUSION; ISCHEMIC-STROKE; DIRECT ASPIRATION;

D O I：

10.1136/neurintsurg-2020-016412

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background In large vessel occlusionstroke, navigation of aspiration catheters (AC) can be impeded by vessel tortuosity and the ophthalmic artery origin. A novel tapered delivery catheter was designed to facilitate delivery without disturbing the embolus. We assessed AC deliverability in vitro and validated the observations in a first-in-human experience. Methods In a vascular model with three challenging craniocervical scenarios, two commercial AC were advanced from the carotid to the middle cerebral artery by four neurointerventionalists. Catheter deliverability with standard microwire and microcatheter (MC) combinations and the Tenzing 7 (T7) Delivery Catheter (Route 92 Medical, San Mateo, CA) were compared. Operators rated aspects of catheter deliverability on a 5-point scale. Results were compared with device delivery patterns at a neurovascular center before and after clinical introduction of T7. Results In vitro, success rate and speed were higher with T7 (96%; mean 30 +/- 10 s) than with MC (65%; 72 +/- 47 s, p<0.001 each), with fewer interactions with the occlusion site (T7: 54% vs MC: 77%, p=0.004). T7 received superior ratings regarding carotid artery deflection (T7: 2, IQR1-3 vs MC: 3, IQR2-3, p<0.001), guide catheter pushback (T7: 2, IQR1-3 vs MC: 3, IQR3-3, p<0.001) and ophthalmic artery passage (T7: 1.5, IQR1-2 vs MC: 4, IQR3-5, p<0.001). Before introduction of T7 at a single center, delivery of AC to a large vessel occlusion without crossing was achieved in 15/123 cases (12%). With T7, this rate was 28/31 patients (90.3%). Conclusion Compared with microcatheter and microwire combinations, T7 improves aspiration catheter delivery in vitro, minimizing the need to cross the occlusion. Initial clinical experience appears to validate the model's observations.

引用

页码：722 / 726

页数：5

共 17 条

[1] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[2] The Aspirations of Direct Aspiration for Thrombectomy in Ischemic Stroke: A Critical Analysis [J].

Andersson, Tommy ;

Wiesmann, Martin ;

Nikoubashman, Omid ;

Gopinathan, Anil ;

Bhogal, Pervinder ;

Yeo, Leonard L. L. .

JOURNAL OF STROKE, 2019, 21 (01) :2-+

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[5] Risk of distal embolization with stent retriever thrombectomy and ADAPT [J].

Chueh, Ju-Yu ;

Puri, Ajit S. ;

Wakhloo, Ajay K. ;

Gounis, Matthew J. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2016, 8 (02) :197-202

[6] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[7] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

[8] 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 [J].

Lapergue, Bertrand ;

Blanc, Raphael ;

Gory, Benjamin ;

Labreuche, Julien ;

Duhamel, Alain ;

Marnat, Gautier ;

Saleme, Suzana ;

Costalat, Vincent ;

Bracard, Serge ;

Desal, Hubert ;

Mazighi, Mikael ;

Consoli, Arturo ;

Piotin, Michel .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 318 (05) :443-452

[9] Reasons for failed endovascular recanalization attempts in stroke patients [J].

Leischner, Hannes ;

Flottmann, Fabian ;

Hanning, Uta ;

Broocks, Gabriel ;

Faizy, Tobias Djamsched ;

Deb-Chatterji, Milani ;

Bernhardt, Martina ;

Brekenfeld, Caspar ;

Buhk, Jan-Hendrik ;

Gellissen, Susanne ;

Thomalla, Goetz ;

Gerloff, Christian ;

Fiehler, Jens .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2019, 11 (05) :439-+

[10] Classification of cavernous internal carotid artery tortuosity: a predictor of procedural complexity in Pipeline embolization [J].

Lin, Li-Mei ;

Colby, Geoffrey P. ;

Jiang, Bowen ;

Uwandu, Chiedozie ;

Huang, Judy ;

Tamargo, Rafael J. ;

Coon, Alexander L. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2015, 7 (09) :628-633

← 1 2 →