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Single-Center Experience Using the 3MAX Reperfusion Catheter for the Treatment of Acute Ischemic Stroke with Distal Arterial Occlusions

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Abstract

Purpose

Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3.8 F) reperfusion catheter for the recanalization of distal intracranial arteries.

Methods

From August 2015 to December 2016, 32 consecutive patients (16 females, 50%; mean age = 67.4 ± 18.7 years, range: 22–91) for 38 distal occlusions underwent mechanical thrombectomy (MT) by thromboaspiration using the 3MAX. Median NIHSS score at admission was 14 (IQR: 9–19). Distal occlusions were distributed as follows: M2 (n: 23), M3 (n: 6), P1 (n: 3), P2 (n: 2), P3 (n: 2), A3 segment (n: 1) and superior cerebellar artery (n: 1).

Results

In 1/38 (2.6%) target artery, the 3MAX could not be navigated. Of the 37 (59.5%) remaining arteries, 22 were successfully reperfused (TICI 2b/3) after ADAPT with the 3MAX alone. Additional stent retriever thrombectomy allowed a 76.3% final reperfusion rate. Good functional outcome (mRS ≤2) was obtained in 45.5% of patients at 3 months. Three (9.4%) 3MAX-related complications occurred: 2 emboli to new territory (ENT) and one vascular perforation.

Conclusions

The 3MAX is well-navigable in distal arteries making it useful as a frontline technique. However, the reperfusion rate with the 3MAX catheter alone seems lower than the ones reported with stent retrievers for such distal occlusions.

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Abbreviations

AcomA:

Anterior Communicating Artery

ACA:

Anterior Cerebral Artery

ADAPT:

A Direct Aspiration First-Pass Thrombectomy

AIS:

Acute Ischemic Stroke

DSA:

Digital Subtraction Angiography

ENT:

Embolus to New Territory

IVT:

Intravenous Thrombolysis

LVO:

Large Vessel Occlusion

MCA:

Middle Cerebral Artery

mRS:

Modified Rankin Scale

MRI:

Magnetic Resonance Imaging

MT:

Mechanical Thrombectomy

NIHSS:

National Institute of Health Stroke Scale

PCA:

Posterior Cerebral Artery

r-TPA:

Recombinant Tissue Plasminogen Activator

SCA:

Superior Cerebellar Artery

SICH:

Symptomatic Intracranial Hemorrhage

TICI:

Thrombolysis in Cerebral Infarction

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Acknowledgements

The authors of this manuscript would like to thank Ms. Christine Pires for her kind help with the collection of clinical data.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, 47–83 Boulevard de l’Hôpital, 75013, Paris, France

    Kévin Premat, Bruno Bartolini, Eimad Shotar, Joseph Gabrieli, Silvia Pistocchi, Jacques Chiras, Nader Sourour & Frédéric Clarençon

  2. Department of Vascular Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France

    Flore Baronnet-Chauvet, Charlotte Rosso & Yves Samson

  3. UPMC Univ Paris-06, Sorbonne Universités, Paris, France

    Flore Baronnet-Chauvet, Vincent Degos, Joseph Gabrieli, Charlotte Rosso, Jacques Chiras, Sonia Alamowitch, Yves Samson & Frédéric Clarençon

  4. Department of Neuro-Intensive Care, Pitié-Salpêtrière Hospital, AP-HP, Paris, France

    Vincent Degos

  5. Department of Vascular Neurology, Saint-Antoine Hospital, AP-HP, Paris, France

    Paul Muresan & Sonia Alamowitch

  6. Department of Interventional Neuroradiology, Foch hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France

    Federico Di Maria

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  1. Kévin Premat
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  2. Bruno Bartolini
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  3. Flore Baronnet-Chauvet
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  9. Charlotte Rosso
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  10. Silvia Pistocchi
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  14. Yves Samson
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  15. Frédéric Clarençon
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Corresponding author

Correspondence to Frédéric Clarençon.

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Conflict of interest

N. Sourour is proctor for the Pipeline Embolization Device and for the Medina Embolization Device (Medtronic). F. Clarençon is consultant for Medtronic, Balt (paid lectures) and for Codman Neurovascular (Study Core lab). K. Premat, B. Bartolini, F. Baronnet-Chauvet, E. Shotar, V. Degos, P. Muresan, F. Di Maria, J. Gabrieli, C. Rosso, S. Pistocchi, J. Chiras, S. Alamowitch and Y. Samson declare that they have no competing interests.

Ethical standards

Neither approval of the institutional review board nor patient informed consent are required by the ethics committee of our institution for retrospective analyses of patients’ records and imaging data.

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Contributorship

All authors made a substantial, direct, and intellectual contribution to the work. Kévin Premat: Data collection, manuscript redaction, statistical analysis. Bruno Bartolini: Data collection, critical review of the manuscript. Flore Baronnet-Chauvet: Data collection. Eimad Shotar: Data collection, critical review of the manuscript. Vincent Degos: Critical review of the manuscript. Paul Muresan: Data collection. Federico Di Maria: Data collection. Joseph Gabrieli: Manuscript editing. Charlotte Rosso: Critical review of the manuscript. Silvia Pistocchi: Critical review of the manuscript. Jacques Chiras: Study supervision. Nader Sourour: Manuscript editing. Sonia Alamowitch: Critical review of the manuscript. Yves Samson: Critical review of the manuscript. Frédéric Clarençon: Study supervisor, critical review of the manuscript.

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Premat, K., Bartolini, B., Baronnet-Chauvet, F. et al. Single-Center Experience Using the 3MAX Reperfusion Catheter for the Treatment of Acute Ischemic Stroke with Distal Arterial Occlusions. Clin Neuroradiol 28, 553–562 (2018). https://doi.org/10.1007/s00062-017-0594-8

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