Document resource
Introduction Mechanical thrombectomy (MT) is the established standard of care for the treatment of large vessel occlusion (LVO) stroke. However, recent randomized trials in medium vessel occlusions (MeVO) have demonstrated neutral clinical outcomes, raising questions regarding patient selection, therapeutic margin, and device-vessel mismatch in smaller, more fragile distal arteries. Purpose-designed distal aspiration systems, with reduced reliance on adjunctive stentrievers, have been proposed as a strategy to optimize safety and efficacy. The Socrates 38 (Scientia Vascular, West Valley City, UT) is a 0.038-inch inner diameter microfabricated nitinol aspiration catheter, which we critically evaluate for performance and safety in both large and medium vessel occlusion thrombectomy.Methods Prospectively maintained thrombectomy databases at 9 institutions were queried for MT using the Socrates 38 as a primary aspiration catheter. Patient demographics and procedural parameters were analyzed, as well as safety and effectiveness outcomes. Data were summarized using descriptive statistics.Results During the study period, 101 patients (median age 72 [IQR 65-78]) were identified as having undergone MT using the Socrates 38 aspiration catheter. The study population included 12 patients with LVO, 64 with primary MEVO, and 25 with secondary MEVO following a more proximal LVO thrombectomy. Cohort-specific data are presented in figure 1. Across the total population, the median time to recanalization was 35 minutes [IQR 18.5-52]. Aspiration alone was sufficient for final reperfusion in 81% of cases (82/101), 14% (14/101) required the use of a stentriever, and rescue intracranial stenting was required for ultimate reperfusion in 5% of cases (5/101). Ninety-one percent (91/101) achieved TICI2B or better reperfusion. In patients with complete follow-up data (n=68), 44% (30/68) of patients achieved a good functional outcome (MRS 0-2) at 90-days. There were two reported cases of sICH and no reports of device damage across the population.Conclusion The Socrates 38 aspiration catheter was associated with acceptable first-pass effect, high rates of aspiration-only reperfusion, and low procedural complication rates in the treatment of medium vessel occlusion (MeVO) stroke. These preliminary findings support further prospective evaluation.Additional Information Acknowledgements The Segal Family Foundation provides grant support for the Segal Family Internship in Cerebrovascular Medicine.Disclosures I. Maiewski: None. M. Lavieri: None. R. Singh: None. B. Gross: None. A. Al-Bayati: None. E. Quach: None. D. Giurgiutiu: None. D. Babici: None. K. Amuluru: None. D. Sahlein: None. V. Doss: None. B. Jankowitz: None. J. Haimi: None. K. Shah: None.Abstract E-222 Table 1LVO (n=12)Primary MEVO(n=64) *[n=63]Secondary MEVO (n=25)Median age (years)65.371.770.4Median pre-procedure NIHSS18.713*18.8Median post-procedure NIHSS13.89.7*14.4First pass TICI 2b>7 (58%)41 (64%)17 (68%)Final TICI 2B> reperfusion12 (100%)57 (89%)22 (88%)Successful aspiration-only thrombectomy8 (75%)57 (89%)18 (72%)Procedural complication rate1 (8%)1 (2%)0 (0%)% 90-day MRS of 0-21/625/47 (53%)4/15 (27%)90-day mortality3/68/47 (17%)8/15 (53%)