Zarrin David A, Laghari Fahad J, Campos Jessica K, Meyer Benjamen M, Khan Muhammad W, Collard de Beaufort Jonathan, Amin Gizal, Beaty Narlin B, Bender Matthew T, Suzuki Shuichi, Colby Geoffrey P, Coon Alexander L
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ, USA.
Interv Neuroradiol. 2024 Dec 10:15910199241299480. doi: 10.1177/15910199241299480.
Recent literature continues to demonstrate the successful role of large-bore aspiration catheters in thrombus ingestion during mechanical thrombectomy. However catheter-to-microwire step-off and distal navigation are ongoing challenges in thrombectomy. A new to market 0.035' macrowire (Aristotle 35 Colossus Guidewire, Scientia Vascular, West Vale City, UT) may address such challenges. We report here our early experience in 30 mechanical thrombectomy cases.
We analyzed a prospectively maintained database of the senior authors to identify cases utilizing a 0.035' macrowire with 0.035' aspiration catheters for mechanical thrombectomy.
Thirty consecutive cases were identified. Seventeen (57%) patients were female with an average age of 75.3 ± 2.2 years (range 55-97). Average presenting NIHSS was 13.0 ± 1.7. Thrombus locations included 7% ( = 2) in the cervical ICA, 47% ( = 14) in the M1, 43% ( = 13) in the M2, and 3% ( = 1) in the P1. An 088' ID aspiration catheter was navigated to at least the M1 segment in all anterior circulation cases and the basilar in the posterior circulation case. The 0.035' macrowire was placed proximal to the occlusion in all cases allowing coaxial 035' and 071' catheter aspiration passes. TICI 2C/3 was achieved in 87% of cases ( = 26) and TICI 2B in the remaining cases. There were no wire-related perforations or vessel dissections.
The Colossus 0.035' macrowire may offer advantages over its smaller counterparts by reducing ledge effect and the need to cross the thrombus. Further comparative studies against currently available microwires in various anatomies are warranted.
近期文献持续证明大口径抽吸导管在机械取栓过程中摄取血栓方面的成功作用。然而，导管与微导丝之间的台阶效应及远端导航仍是取栓过程中持续存在的挑战。一种新上市的0.035英寸的粗导丝（亚里士多德35巨像导丝，科学血管公司，犹他州韦斯特维尔市）可能解决此类挑战。我们在此报告我们在30例机械取栓病例中的早期经验。
我们分析了资深作者前瞻性维护的数据库，以确定使用0.035英寸粗导丝搭配0.035英寸抽吸导管进行机械取栓的病例。
共确定了30例连续病例。17例（57%）患者为女性，平均年龄75.3±2.2岁（范围55 - 97岁）。入院时美国国立卫生研究院卒中量表（NIHSS）平均评分为13.0±1.7。血栓位置包括颈内动脉（ICA）7%（n = 2）、M1段47%（n = 14）、M2段43%（n = 13）以及P1段3%（n = 1）。在所有前循环病例中，一根0.088英寸内径的抽吸导管至少被导航至M1段，后循环病例中则被导航至基底动脉。在所有病例中，0.035英寸粗导丝均置于闭塞近端，允许同轴进行0.035英寸和0.071英寸导管抽吸操作。87%的病例（n = 26）实现了脑梗死溶栓分级（TICI）2C/3级，其余病例为TICI 2B级。未发生与导丝相关的穿孔或血管夹层。
巨像0.035英寸粗导丝可能比其较细的同类产品具有优势，可减少台阶效应并降低穿过血栓的必要性。有必要针对当前各种解剖结构中可用的微导丝进行进一步的对比研究。
