At the OCIN conference that has just ended, a salon themed “Long-lasting Advantages from Deep Dive”, where cases of aspiration thrombectomy for acute ischemic strokes were shared, attracted much attention. Over a hundred neurointervention experts from China attended the conference to discuss ADAPT and exchange experience of clinical uses of ACE aspiration catheters.
The conference invited prof. Peter Schramm, director of Promise Lab, prof. Liu Jianmin of Changhai Hospital, and other experts to have inspiring exchange on ADAPT with 12 ACE cases, which covered anterior circulation, posterior circulation, tandem lesion and other cases.
| Peter Schramm: Latest Results of the Promise Study
Background and Purpose
The recent randomized trials demonstrated the benefit of mechanical thrombectomy in stroke therapy. However, treatment using different strategies is an ongoing area of investigation. The PROMISE study analyzed the safety and effectiveness of the Penumbra System with the ACE68 and ACE64 reperfusion catheters in aspiration thrombectomy of stroke, using A Direct Aspiration First Pass Technique (ADAPT).
PROMISE was a prospective study which enrolled 204 patients with intracranial anterior circulation large vessel occlusion (LVO) ischemic stroke in 20 centers from February 2016 to May 2017. Initial treatment was with the ACE68/ACE64 catheters within 6?hours of symptom onset. Imaging and safety review was performed by an independent Core Laboratory and a Clinical Events Committee. The primary angiographic outcome was revascularization to mTICI 2b-3 at immediate post-procedure and the primary clinical outcome was 90-day modified Rankin Scale (mRS) score ≤2. Safety assessment included device and procedure-related serious adverse events (SAEs), symptomatic intracranial hemorrhage (sICH), mortality, and embolization of new territory (ENT).
Enrolled patients had a median age of 74 (IQR 65-80) years and a median admission NIHSS of 16 (IQR 11-20). The post-procedure mTICI 2b-3 revascularization rate was 93.1% and the 90-day mRS 0-2 rate was 61%. Device and procedure-related SAEs at 24?hours occurred in 1.5% and 3.4%, respectively, 90-day mortality was 7.5%, sICH occurred in 2.9% while ENT occurred in 1.5%.
For frontline therapy of LVO stroke, the ACE68/ACE64 catheters for aspiration thrombectomy were found to be safe and showed similar efficacy to randomized trials using other revascularization techniques.
Liu Jianmin: Aspiration Is Bound to Be First Choice for Intracranial Vessel Recanalization
Prof. Liu Jianmin’s Speech the Salon “Long-lasting Advantages from Deep Dive”
According to prof. Liu Jianmin of Changhai Hospital, Penumbra System has accumulated a large number of cases since many years ago but has not found an opportunity for exchange and discussion. This salon provided a chance to demonstrate the advantages of the aspiration technology.
In explaining ADAPT, prof. Liu drew an analogy. “To get rid of scraps of paper from a clean table, what tool will have the minimum effect on the table: a vacuum cleaner, a broom, a scoop, or a cleaning cloth?”
“While aspiration has the minimum damage to the vessel, it has similar recanalization rate to that of the stents (and even higher in some trials). If we can use aspiration to address intracranial occlusion, it is bound to be better than Solumbra and stents, considering its minimum damage to the vessel.”
“To make the first trial, we are sure to choose the method with the minimum damage. I believe aspiration is the first choice for intracranial vessel recanalization.”
To get rid of scraps of paper from a clean table, we will choose the vacuum cleaner that is most unlikely to cause damage and does a very good cleaning. Similarly, when clots or other “foreign objects” occur in the vessel, why not we try the rapid and efficient technology with the minimum damage?
As the only CFDA-approved intracranial thrombus aspiration system, the ACE aspiration catheter and Penumbra system have adopted continuous technical innovations. Since their introduction to the market in May this year, operators have used the system to save more than a hundred ischemic stroke patients. The continuous accumulation of clinical uses has optimized the ADAPT technology, bringing ever better outcomes for the patients.
Optimization of neurointervention procedures to enhance the level of clinical application is the constant pursuit of neurointervention physicians in China. In this regard, aspiration thrombectomy has long-lasting advantages from deep dive.