Goyal Nitin, Khattar Nicolas K, Peterson Jeremy, Dashti Reza, Sims Jason J, Baumeister Marlene, Williams Ari, Amadi Iheanyi, Ebersole Koji, Madigan Dawn, Symonds Dina, Gottschlich Melissa, Inoa-Acosta Violiza, Frei Donald, Fiorella David
Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
J Neurointerv Surg. 2025 Apr 8. doi: 10.1136/jnis-2025-023132.
Recent studies support the effectiveness of mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs). The RED 43 catheter has been introduced as a primary catheter for distal aspiration in acute ischemic stroke. In this multicenter study, we share our experience of using the RED 43 catheter for MT in DMVOs.
We identified consecutive patients with DMVOs who underwent primary aspiration thrombectomy using the RED 43 catheter at four high-volume stroke centers. We collected baseline clinical data, angiographic and clinical outcomes, and procedural complications. We divided the patients into two groups: those with primary DMVOs included patients who presented with more distal occlusions requiring mechanical thrombectomy; and those with secondary DMVOs being patients presenting with large vessel occlusion that later developed a DMVO. Primary outcomes included the rate of first pass effect, (modified treatment in cerebral infarction (mTICI) 2c or 3 on the first pass) and successful recanalization (mTICI≥2b at end of procedure). Secondary outcomes included good functional outcomes (modified Rankin Scale (mRS) 0-2 at 3 months), symptomatic intracerebral hemorrhage (sICH), asymptomatic intracerebral hemorrhage (aICH), subarachnoid hemorrhage (SAH), and in-hospital mortality.
We identified 102 consecutive DMVO cases undergoing thrombectomy with the RED 43 catheter. The mean age was 70 years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 9. The first pass effect (FPE) rate was 57% (primary) and 61% (secondary). Successful recanalization occurred in 83% (primary) and 87% (secondary). Good functional outcome was observed in 57% of patients. sICH occurred in one patient, and two patients died during hospitalization. We observed aICH in five (4.9%) patients and SAH in seven (6.9%) patients.
The RED 43 catheter is safe and effective for aspiration thrombectomy in primary and secondary DMVOs, with high recanalization rates and a favorable safety profile.
近期研究支持机械取栓术（MT）对远端中等血管闭塞（DMVO）的有效性。RED 43导管已被引入作为急性缺血性卒中远端抽吸的主要导管。在这项多中心研究中，我们分享使用RED 43导管对DMVO进行MT的经验。
我们确定了在四个高容量卒中中心使用RED 43导管进行初次抽吸取栓术的连续性DMVO患者。我们收集了基线临床数据、血管造影和临床结果以及手术并发症。我们将患者分为两组：原发性DMVO患者包括那些出现更远端闭塞需要机械取栓术的患者；继发性DMVO患者是那些出现大血管闭塞随后发展为DMVO的患者。主要结局包括首次通过效应率（首次通过时改良脑梗死治疗（mTICI）2c或3级）和成功再通（手术结束时mTICI≥2b）。次要结局包括良好的功能结局（3个月时改良Rankin量表（mRS）0 - 2级）、症状性脑出血（sICH）、无症状性脑出血（aICH）、蛛网膜下腔出血（SAH）和住院死亡率。
我们确定了102例连续性DMVO病例使用RED 43导管进行取栓术。平均年龄为70岁，美国国立卫生研究院卒中量表（NIHSS）评分中位数为9分。首次通过效应（FPE）率为57%（原发性）和61%（继发性）。成功再通率在原发性患者中为83%，继发性患者中为87%。57%的患者观察到良好的功能结局。1例患者发生sICH，2例患者在住院期间死亡。我们观察到5例（4.9%）患者发生aICH，7例（6.9%）患者发生SAH。
RED 43导管对原发性和继发性DMVO的抽吸取栓术安全有效，再通率高且安全性良好。
