Neurointervention.  2023 Mar;18(1):30-37. 10.5469/neuroint.2022.00479.

Initial Experience Using the New pHLO 0.072-inch Large-Bore Catheter for Direct Aspiration Thrombectomy in Acute Ischemic Stroke

• Leone G
• Muto M
• Giordano F
• Guarnieri G
• Donna AD
• Russo C
• Romano DG
• Candelaresi P
• Servillo G
• Spina E
• Mase AD
• Andreone V
• Muto M

• KMID: 2539944
• DOI: http://doi.org/10.5469/neuroint.2022.00479

Abstract

Purpose
A direct aspiration, first pass technique (ADAPT) has been introduced as a rapid and safe thrombectomy strategy in patients with intracranial large vessel occlusion (LVO). The aim of the study is to determine the technical feasibility, safety, and functional outcome of ADAPT using the newly released large bore pHLO 0.072-inch aspiration catheter (AC; Phenox).
Materials and Methods
We performed a retrospective analysis of data collected prospectively (October 2019–November 2021) from 2 comprehensive stroke centers. Accessibility of the thrombus, vascular recanalization, time to recanalization, and procedure-related complications were evaluated. National Institutes of Health stroke scale scores at presentation and discharge and the modified Rankin scale (mRS) score at 90 days post-procedure were recorded.
Results
Twenty-five patients (14 female, 11 male) with occlusions of the anterior circulation were treated. In 84% of cases, ADAPT led to successful recanalization with a median procedure time of 28 minutes. In the remaining cases, successful recanalization required (to a total of 96%; modified thrombolysis in cerebral infarction score 2b/3) the use of stent retrievers. No AC-related complications were reported. Other complications included distal migration of the thrombus, requiring a stent-retriever, and symptomatic PH2 hemorrhage in 16% and 4%, respectively. After 3 months, 52% of the patients had mRS scores of 0–2 with an overall mortality rate of 20%.
Conclusion
Results from our retrospective case series revealed that thrombectomy of LVOs with pHLO AC is safe and effective in cases of large-vessel ischemic stroke. Rates of complete or near-complete recanalization after the first pass with this method might be used as a new benchmark in future trials.

Keyword

Acute ischemic stroke; Intervention; Stroke; Thrombectomy; Aspiration

Figure

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  Fig. 1. Septuagenarian with a National Institutes of Health stroke scale score of 15, Alberta stroke program early computed tomography score 10 (A), and a right M1 occlusion in computed tomography angiography (B). Digital subtraction angiography in anteroposterior (C) and lateral view (D) confirmed the M1 occlusion with good leptomeningeal collateral circulation. (E, F) Navigation of the pHLO to the thrombus was not possible due to unsuccessful passage through the origin of the ophthalmic artery, so a stent-retriever (Embotrap III 6x45; Cerenovus) was used to anchor and advance the pHLO aspiration catheter. (G, H) Thrombolysis in cerebral infarction score 3 after combined technique. After 3 months the patient’s modified Rankin scale score was 1.

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  Fig. 2. Septuagenarian with a National Institutes of Health stroke scale score of 20. (A) Computed tomography (CT) showed Alberta stroke program early CT score (ASPECT) 7, spontaneous hyperdensity of the left siphon apex extended to the entire M1-M2 tract of the left middle cerebral artery (MCA) (large clot burden). (B) CT angiography confirmed “L” siphon occlusion extended to M1-M2 of the left MCA while perfusion CT angiography obtained by RAPID automated processing showed good mismatch. (C) Digital subtraction angiography confirmed the “L” siphon occlusion (anteroposterior and lateral view). (D) Position of the pHLO at the left siphon apex (anteroposterior and lateral view). (E) Very large entire red clot recovered at first pass. (F) Modified thrombolysis in cerebral infarction score 3 obtained within a procedure time of 18 minutes, anteroposterior and lateral view. (G) CT scan at 24 hours confirmed ASPECT 7. After 3 months the patient’s modified Rankin scale score was 1.

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