Neurointervention.  2024 Nov;19(3):139-147. 10.5469/neuroint.2024.00171.

First-Line Aspiration Thrombectomy of M2 Occlusions with a Novel Reperfusion Catheter (RED^TM 62): Real-World Experience from Two Tertiary Comprehensive Stroke Centers

• Grieb D
• Wensing H
• Schulz K
• Loehr C
• Lanfermann H
• Schlunz-Hendann M
• Boxberg F

• KMID: 2560217
• DOI: http://doi.org/10.5469/neuroint.2024.00171

Abstract

Purpose
The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical features and initial results of a novel reperfusion catheter (RED^TM 62) used for frontline aspiration thrombectomy of M2 occlusions in acute ischemic stroke patients. Appropriate aspiration catheters are crucial for a successful ADAPT maneuver; however, the selection of catheters suitable for smaller-sized vessels is scarce compared to the ones for large vessel occlusions.
Materials and Methods
All patients treated with ADAPT using RED^TM 62 as the frontline treatment approach for acute M2 occlusions between December 2022 and February 2024 were retrospectively enrolled. Demographic data, procedural timings and safety, recanalization rates, and outcome data were recorded.
Results
Twenty patients with a median admission National Institutes of Health Stroke Scale (NIHSS) score of 8 were identified. Successful revascularization (DMVO-thrombolysis in cerebral infarction [TICI]≥2b) with RED^TM 62 aspiration thrombectomy was obtained in 65.0% (13/20) of cases. The first pass effect was 45.0% (9/20). In 2 cases, the RED^TM 62 did not reach the clot due to marked distal vessel tortuosity. Stent retrievers were additionally used in 9 cases and led to an overall DMVO-TICI 2c/3 of 90.0% (18/20). Mean procedural time was 48 minutes. No complications directly related to ADAPT occurred. In-hospital mortality rate was 20.0% (4/20). The median discharge NIHSS score was 2.5. A good functional outcome at discharge (modified Rankin scale 0-2) was achieved in 55.0% (11/20) of cases.
Conclusion
Our initial experiences with the novel RED^TM 62 reperfusion catheter for treatment of M2 occlusions is in line with published data. ADAPT using this catheter may be considered as a safe and effective first-line treatment option. Further studies are warranted to validate the initial results.

Keyword

Stroke; Thrombectomy; Reperfusion; Catheter

Figure

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  Fig. 1. Middle aged patient with an acute left superior trunk M2 occlusion (arrows in A, B). National Institutes of Health Stroke Scale (NIHSS) 5 at admission, 2 hours from symptom onset, pre-stroke modified Rankin scale (mRS) 1. A direct aspiration first pass technique with REDTM 62 (Penumbra, Inc.) (first pass) led to distal medium vessel occlusion thrombolysis in cerebral infarction 3 (E, F; arrows in C, D indicate catheter tip). No infarction on 24 hours follow-up cranial computed tomography (G). NIHSS 0 and mRS 1 at discharge. Note concomitant distal dorsoparietal M4 occlusion (arrowheads in B, F, H).

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