J Cerebrovasc Endovasc Neurosurg.  2014 Dec;16(4):350-357. 10.7461/jcen.2014.16.4.350.

Initial Experience Using the 5MAX(TM) ACE Reperfusion Catheter in Intra-arterial Therapy for Acute Ischemic Stroke

• John S
• Hussain MS
• Toth G
• Bain M
• Uchino K
• Hui FK

• KMID: 1738340
• DOI: http://doi.org/10.7461/jcen.2014.16.4.350

Abstract

OBJECTIVES
The 5MAX ACE is a new large bore aspiration catheter available for vessel recanalization for treatment of acute ischemic stroke (AIS). We report our initial experience with its use.
METHODS
A retrospective analysis of patients undergoing intra-arterial therapy for AIS using the 5MAX ACE reperfusion catheter at our institution was performed. Patient demographics, clinical characteristics and procedural data were obtained from chart review. Successful recanlization was defined as achievement of Thrombolysis in Cerebral Infarction score (TICI) 2b-3 and time to recanalization was defined as time from groin puncture to achievement of at least TICI 2b recanalization.
RESULTS
The 5MAX ACE was used in 15 patients from July-October 2013. Direct aspiration was used as the primary technique in 10/15 (67%) patients. Out of these, aspiration alone was sufficient for recanalization in 3 (20%) patients. In the remaining 7 (47%) patients, additional devices were used. In 5/15 (33%) patients, combined aspiration/stentriever thrombectomy using Solitaire(TM) (3/5 patients) and Penumbra 3D Separator(TM) (2/5 patients) were used as the primary technique. Successful recanlization (TICI 2b-3) was achieved in 11/15 (73%) patients. Average time from groin puncture to successful recanalization was 46 +/- 30 minutes (range 14-98 minutes). There were no procedural complications.
CONCLUSION
The 5MAX ACE is a useful recanalization tool, either by direct aspiration or combined stentriever/aspiration. It may be most advantageous with large clots in the internal carotid artery. The potential for effective and faster recanalization using this device alone or in combination may be a good topic for future study.

Keyword

Acute stroke; Cerebral revascularization; Endovascular procedures; Mechanical aspiration

MeSH Terms

Carotid Artery, Internal
Catheters*
Cerebral Infarction
Cerebral Revascularization
Demography
Endovascular Procedures
Groin
Humans
Punctures
Reperfusion*
Retrospective Studies
Stroke*
Suction
Thrombectomy

Figure

• 

  Fig. 1 Diagram showing the direct aspiration technique. First (A), the microwire is advanced past the clot and the microcatheter is advanced to the face of the clot. The 5MAX ACE is then advanced over the microcatheter to the face of the clot (B). The microwire and microcatheter are then removed (C), and suction is applied to the 5MAX ACE (D).

• 

  Fig. 2 Patient No 1. Left internal carotid artery (LICA) thrombus with thrombolysis in cerebral infarction (TICI) score 0 flow. After the first attempt with direct aspiration, flow was restored in the LICA. Post intervention angiogram shows TICI score 3 recanalization.

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  Fig. 3 Patient No. 15. Basilar apex is occluded with absence of opacification of bilateral posterior cerebral arteries. First two attempts at direct aspiration were unsuccessful. After the third attempt at direct aspiration, the basilar occlusion was recanalized with establishment of thrombolysis in cerebral infarction score 2b flow.

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  Fig. 4 Patient No 6. Left middle cerebral artery is occluded in the proximal segment with thrombolysis in cerebral infarction (TICI) score 0 flow. After the first attempt at combined stent retriever thrombectomy and aspiration, the LM1 was recanalized, with TICI score 2b flow subsequently established.

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