Initial experience with SOFIA as an intermediate catheter in mechanical thrombectomy for acute ischemic stroke.

Autor:	Wong JHY; Department of Neurosurgery, Stanford University Hospital, Stanford, California, USA., Do HM; Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA., Telischak NA; Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA., Moraff AM; Department of Neurosurgery, Stanford University Hospital, Stanford, California, USA., Dodd RL; Department of Neurosurgery, Stanford University Hospital, Stanford, California, USA., Marks MP; Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA., Ingle SM; Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA., Heit JJ; Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2017 Nov; Vol. 9 (11), pp. 1103-1106. Date of Electronic Publication: 2016 Oct 27.
DOI:	10.1136/neurintsurg-2016-012750
Abstrakt:	Background: The benefits of mechanical thrombectomy for emergent large vessel occlusion (ELVO) have been established. Combined mechanical/aspiration (Solumbra) and a direct aspiration as a first pass technique (ADAPT) are valid procedures requiring an intermediate catheter for clot suction. Recently, SOFIA (Soft torqueable catheter Optimized For Intracranial Access) was developed as a single lumen flexible catheter with coil and braid reinforcement, but its suitability for mechanical thrombectomy had not been evaluated. Objective: To describe our initial experience with SOFIA in acute stroke intervention and evaluate its efficacy and safety. Methods: All patients with ELVO undergoing endovascular stroke intervention with SOFIA were identified. Demographic, presentation, treatment, and complication data were recorded. Primary outcome was Thrombolysis in Cerebral Infarction (TICI) 2b/3 revascularization rate and the number of passes required. Secondary outcomes included complication rates and discharge National Institute of Health Stroke Scale (NIHSS) score. Results: 33 patients with a mean age of 72 years were treated for ELVO with SOFIA and IV tissue plasminogen activator was administered in 67%. Vessel occlusion involved the internal carotid artery (15.2%), M1 (48.5%), and M2 (24.2%) segments, and posterior circulation (12.1%). Median presentation NIHSS score was 14 (IQR 11-19) and discharge NIHSS 4 (IQR 2-14). The Solumbra technique represented 94% of treatments and ADAPT 3%. The TICI 2b/3 revascularization rate was 94%, including 48.5% TICI 3 with an average of 1.6 passes. The symptomatic reperfusion hemorrhage rate was 6%. Procedural complications occurred in four patients, but were unrelated to SOFIA. Mortality was 21%, secondary to failed revascularization, hemorrhagic transformation, and baseline medical condition. Conclusions: Mechanical and aspiration thrombectomy with SOFIA is safe and effective with high revascularization rates. Its trackability, stability, and luminal size make SOFIA suitable for stroke intervention. Competing Interests: Competing interests: JJH and HMD received consulting fees from MicroVention, Inc. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
Databáze:	MEDLINE
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