Carraro do Nascimento Vinicius, Dhillon Permesh Singh, de Villiers Laetitia, Teoh Strahan, Phillips Timothy, Brennan David, Butt Waleed, Al-Tibi Mohammad, Anoni Daniela Mantovani, Malik Luqman, Rice Hal
Department of Interventional Neuroradiology, Gold Coast University Hospital, Queensland, Australia.
Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.
Interv Neuroradiol. 2025 Jun 12:15910199251346007. doi: 10.1177/15910199251346007.
BackgroundFor medium vessel occlusions (MeVOs), in acute ischaemic stroke (AIS), the clinical efficacy of mechanical thrombectomy (MT) is the topic of ongoing randomised clinical trials, and the optimal recanalisation technique remains undetermined. We aim to assess the effectiveness and safety of the novel RED 43 distal reperfusion catheter for the treatment of MeVOs.MethodsWe retrospectively reviewed consecutive cases of anterior and posterior circulation MT for MeVO where the RED 43 aspiration catheter was used at four comprehensive stroke centres in Australia and United Kingdom, from April 2023 to June 2024. Procedural outcomes (navigation to the target vessel, final near complete-complete recanalisation (extended Thrombolysis in Cerebral Infarction (eTICI) 2c-3) and single-pass eTICI 2c-3 (first-pass effect (FPE)), 90-day modified Rankin score, safety and procedural complications (haemorrhagic, vessel dissection or perforation) were analysed.ResultsSeventy-four patients were included (median age 72.8 years [SD 13.1]; 33.8% females). Median baseline NIHSS was 10 [iQR 5-15], and median ASPECTS was 9. Primary MeVOs (without large vessel occlusion) accounted for 58.1% of cases. The occlusion site was reached using the RED 43 in 100% of cases. In particular, the target was reached navigating the catheter over a microwire only in 83.8% of cases. Fifty-seven (77%) patients achieved final eTICI 2c-3 and the FPE (eTICI 2c-3) for the RED 43 was 60.8%. Modified Rankin Scale (mRS) ≤ 2 at 90-days was 67.1%. No intraprocedural complications were recorded. Symptomatic intracranial haemorrhage and 90-day mortality rates were 4.1% and 19%, respectively.ConclusionThe novel RED 43 distal aspiration catheter was shown to be safe and effective in achieving good technical and clinical outcomes amongst acute stroke patients presenting with MeVO. If MT for MeVO is proven to be efficacious, future studies should aim to compare available MT techniques in achieving fast and complete vessel recanalisation.
背景
对于急性缺血性卒中（AIS）中的中型血管闭塞（MeVO），机械取栓术（MT）的临床疗效是正在进行的随机临床试验的主题，最佳再通技术仍未确定。我们旨在评估新型RED 43远端再灌注导管治疗MeVO的有效性和安全性。
方法
我们回顾性分析了2023年4月至2024年6月期间在澳大利亚和英国的四个综合卒中中心连续进行的前循环和后循环MT治疗MeVO的病例，这些病例使用了RED 43抽吸导管。分析了手术结果（导航至目标血管、最终接近完全再通（扩展脑梗死溶栓（eTICI）2c-3）和单次通过eTICI 2c-3（首次通过效应（FPE））、90天改良Rankin评分、安全性和手术并发症（出血、血管夹层或穿孔）。
结果
纳入74例患者（中位年龄72.8岁[标准差13.1]；33.8%为女性）。基线NIHSS中位数为10[iQR 5-15]，ASPECTS中位数为9。原发性MeVO（无大血管闭塞）占病例的58.1%。100%的病例使用RED 43到达闭塞部位。特别是，仅通过微导丝引导导管到达目标的病例占83.8%。57例（77%）患者实现了最终的eTICI 2c-3，RED 43的FPE（eTICI 2c-3）为60.8%。90天时改良Rankin量表（mRS）≤2为67.1%。未记录术中并发症。症状性颅内出血和90天死亡率分别为4.1%和19%。
结论
新型RED 43远端抽吸导管在治疗MeVO的急性卒中患者中显示出安全有效，可实现良好的技术和临床结果。如果证明MT治疗MeVO有效，未来的研究应旨在比较现有的MT技术在实现快速和完全血管再通方面的效果。
