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Purpose <p>Techniques for endovascular thrombectomy in acute ischemic stroke due to medium or distal vessel occlusions (MDVO) need to be improved, and first-line aspiration is emerging as a&#xa0;promising technique. The objective was to describe first-pass and final reperfusion rates with a&#xa0;triaxial direct aspiration first pass technique (ADAPT) and a&#xa0;novel, quadriaxial technique (QUATTRO-ADAPT) using RED43 Reperfusion Catheters to target MDVOs.</p> Methods <p>This retrospective study collected data from 11&#xa0;stroke centers in Europe and North America between 2023 and 2025. Patients with primary, isolated MDVOs who underwent thrombectomy using first-line aspiration with RED43 Reperfusion Catheters were included. Primary outcome was first-pass successful reperfusion rate (modified Treatment In Cerebral Infarction score ≥ 2b). Additionally, final reperfusion rates, complications and functional outcomes up to 90&#xa0;days were evaluated.</p> Results <p>We included 85&#xa0;cases. Median age was 74&#xa0;years (IQR 67–81) and median National Institutes of Health Stroke Scale score&#xa0;9 (IQR 6–15). The majority (69.4%) had an occlusion of the co- or nondominant M2 segment of the middle cerebral artery. First-pass successful reperfusion was 63.5% overall, with 55.6% for the triaxial ADAPT and 69.4% for the quadriaxial QUATTRO-ADAPT. Final successful reperfusion was achieved in 96.5%. Complications included vessel perforations (2.4%), subarachnoid hemorrhage (3.5%), parenchymal hematoma type&#xa0;2 (2.4%), and symptomatic intracerebral hemorrhage (1.2%). Functional independence (modified Rankin Scale&#xa0;0–2) at 90&#xa0;days was observed in 58.7%.</p> Conclusion <p>This study shows that first-line aspiration, especially in a&#xa0;quadriaxial approach, can be effective and safe. These findings should be evaluated in prospective trials.</p>

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First-line Aspiration Thrombectomy with the RED43 Catheter for Acute Ischemic Stroke due to Medium or Distal Vessel Occlusion

  • 期刊论文

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  • 发表日期：

    2025年9月29日

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  • Vera Aebischer,
  • Alex Brehm,
  • Nikki Rommers,
  • Alejandro Spiotta,
  • Mohammad Sowlat,
  • Karthik Raghuram,
  • Justin M. Cappuzzo,
  • Jeffrey Beecher,
  • Charles Matouk,
  • Abdelaziz Amllay,
  • Axel Rohr,
  • Manraj Heran,
  • David Volders,
  • Pascal J. Mosimann,
  • Mohammad Al-Tibi,
  • Johan Wassélius,
  • Björn M. Hansen,
  • Markus Holtmannspötter,
  • Martin Schlösser,
  • Stephan Meckel,
  • Oumaima Aoua,
  • Suresh Giragani,
  • Andrea Boghi,
  • Nikolaos Ntoulias,
  • Victor Schulze-Zachau,
  • Ioannis Tsogkas,
  • Kristine A. Blackham,
  • Aikaterini Anastasiou,
  • Marios Psychogios

摘要

Purpose

Techniques for endovascular thrombectomy in acute ischemic stroke due to medium or distal vessel occlusions (MDVO) need to be improved, and first-line aspiration is emerging as a promising technique. The objective was to describe first-pass and final reperfusion rates with a triaxial direct aspiration first pass technique (ADAPT) and a novel, quadriaxial technique (QUATTRO-ADAPT) using RED43 Reperfusion Catheters to target MDVOs.

Methods

This retrospective study collected data from 11 stroke centers in Europe and North America between 2023 and 2025. Patients with primary, isolated MDVOs who underwent thrombectomy using first-line aspiration with RED43 Reperfusion Catheters were included. Primary outcome was first-pass successful reperfusion rate (modified Treatment In Cerebral Infarction score ≥ 2b). Additionally, final reperfusion rates, complications and functional outcomes up to 90 days were evaluated.

Results

We included 85 cases. Median age was 74 years (IQR 67–81) and median National Institutes of Health Stroke Scale score 9 (IQR 6–15). The majority (69.4%) had an occlusion of the co- or nondominant M2 segment of the middle cerebral artery. First-pass successful reperfusion was 63.5% overall, with 55.6% for the triaxial ADAPT and 69.4% for the quadriaxial QUATTRO-ADAPT. Final successful reperfusion was achieved in 96.5%. Complications included vessel perforations (2.4%), subarachnoid hemorrhage (3.5%), parenchymal hematoma type 2 (2.4%), and symptomatic intracerebral hemorrhage (1.2%). Functional independence (modified Rankin Scale 0–2) at 90 days was observed in 58.7%.

Conclusion

This study shows that first-line aspiration, especially in a quadriaxial approach, can be effective and safe. These findings should be evaluated in prospective trials.