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One-year single-center experience with the Aperio thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome

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Abstract

Background and purpose

The Aperio thrombectomy device (Aperio) is a stent retriever designed to achieve rapid and substantial flow restoration in acute ischemic stroke due to large-vessel occlusions (LVOs). We evaluated the safety and efficacy of the Aperio device and compared it with published data of established stent retrievers.

Methods

We retrospectively analyzed institutional data of consecutive stroke procedures in patients with LVO in the anterior circulation that were treated between January 2017 and December 2017 with the Aperio. Reperfusion rate regarding to the extended thrombolysis in cerebral infarction scale (eTICI), procedural times, early clinical outcome, and complications were documented.

Results

Eighty-two patients were treated by using the Aperio in LVO in the anterior circulation. Median age was 77 (± 12) years (w = 59.8%). Median Baseline National Institutes of Health Stroke Scale (NIHSS) score was 14. Fifty-three (64.6%) patients received intravenous thrombolysis. Successful recanalization (eTICI≥2b) was achieved in 85.3%. Mean time from groin puncture to final recanalization was 52.3 ± 34.8 min. Embolization to new territories occurred in one case. Symptomatic intracranial hemorrhage within 24 h was observed in six patients (7.3%). Twenty-eight (41.2%) out of 68 patients available for assessment of functional outcome at 3 months achieved favorable outcome (mRS 0–2).

Conclusion

The Aperio stent retriever mechanical thrombectomy device demonstrated high rates of successful reperfusion and a good safety profile in patients with acute ischemic stroke due to LVO in the anterior circulation.

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References

  1. Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PLM, van Rooij WJJ, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Visser MC, Bot JCJ, Vroomen PC, Eshghi O, Schreuder THCML, Heijboer RJJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers MES, Jenniskens SFM, Beenen LFM, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YBWEM, van der Lugt A, van Oostenbrugge RJ, Majoie CBLM, Dippel DWJ (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372(1):11–20

    Article  CAS  Google Scholar 

  2. Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372(11):1009–1018

    Article  CAS  Google Scholar 

  3. Saver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372(24):2285–2295

    Article  CAS  Google Scholar 

  4. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372(24):2296–2306

    Article  CAS  Google Scholar 

  5. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR (2015) American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke. 46(10):3020–3035

    Article  CAS  PubMed  Google Scholar 

  6. Humphries W, Hoit D, Doss VT, Elijovich L, Frei D, Loy D, Dooley G, Turk AS, Chaudry I, Turner R, Mocco J, Morone P, Fiorella D, Siddiqui A, Mokin M, Arthur AS (2015) Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg. 7(2):90–94

    Article  PubMed  Google Scholar 

  7. Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O, Wiesmann M, Knauth M, Mpotsaris A, Psychogios MN (2017) Maximizing first-pass complete reperfusion with SAVE. Clin Neuroradiol:1–12

  8. Tan IYL, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. Am J Neuroradiol 30(3):525–531

    Article  CAS  PubMed  Google Scholar 

  9. Fiorelli M, Bastianello S, von Kummer R, del Zoppo GJ, Larrue V, Lesaffre E, Ringleb AP, Lorenzano S, Manelfe C, Bozzao L (1999) Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort. Stroke 30(11):2280–2284

    Article  CAS  PubMed  Google Scholar 

  10. Kaesmacher J, Dobrocky T, Heldner MR, Bellwald S, Mosimann PJ, Mordasini P, Bigi S, Arnold M, Gralla J, Fischer U (2018) Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited. J Neurol Neurosurg Psychiatry 89(9):910–917

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rizvi A, Seyedsaadat SM, Murad MH, Brinjikji W, Fitzgerald ST, Kadirvel R, Rabinstein AA, Kallmes DF (2019) Redefining ‘success’: a systematic review and meta-analysis comparing outcomes between incomplete and complete revascularization. J Neurointerv Surg 11(1):9–13

    Article  PubMed  Google Scholar 

  12. Goyal M, Menon BK, Van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CBLM, Van Der Lugt A, De Miquel MA, Donnan GA, Roos YBWEM, Bonafe A, Jahan R, Diener HC, Van Den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BCV, Van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 387(10029):1723–1731

    Article  PubMed  Google Scholar 

  13. Campbell BCV, Hill MD, Rubiera M, Menon BK, Demchuk A, Donnan GA, Roy D, Thornton J, Dorado L, Bonafe A, Levy EI, Diener H-C, Hernández-Pérez M, Pereira VM, Blasco J, Quesada H, Rempel J, Jahan R, Davis SM, Stouch BC, Mitchell PJ, Jovin TG, Saver JL, Goyal M (2016) Safety and efficacy of solitaire stent thrombectomy. Stroke. https://doi.org/10.1161/STROKEAHA.115.012360

  14. Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, Saleme S, Costalat V, Bracard S, Desal H, Mazighi M, Consoli A, Piotin M (2017) Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA J Am Med Assoc 318(5):443–452

    Article  Google Scholar 

  15. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot J-M, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG (2017) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med NEJMoa1706442

  16. Zaidat OO, Castonguay AC, Nogueira RG, Haussen DC, English JD, Satti SR, Chen J, Farid H, Borders C, Veznedaroglu E, Binning MJ, Puri A, Vora NA, Budzik RF, Dabus G, Linfante I, Janardhan V, Alshekhlee A, Abraham MG, Edgell R, Taqi MA, Khoury RE, Mokin M, Majjhoo AQ, Kabbani MR, Froehler MT, Finch I, Ansari SA, Novakovic R, Nguyen TN (2017) TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. J Neurointerv Surg (September) neurintsurg-2017-013328

  17. Yi HJ, Lee DH, Kim SU (2018) Effectiveness of Trevo stent retriever in acute ischemic stroke: comparison with solitaire stent. Medicine (Baltimore) 97(20):2–8

    Article  Google Scholar 

  18. Brouwer PA, Yeo LLL, Holmberg A, Andersson T, Kolloch J, Kuntzesöderqvist Å, Ohlsson M, Holmin S, Anastasios M, Gontu VK, Bhogal P, Söderman M (2018) Thrombectomy using the EmboTrap device: Core laboratory-assessed results in 201 consecutive patients in a real-world setting. J Neurointerv Surg:1–6

  19. Nogueira RG (2012) Trevo2. Lancet. 380(9849):1231–1240

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, Narata AP, Francois O, Jadhav AP, Grossberg JA, Riedel CH, Tomasello A, Clark WM, Nordmeyer H, Lin E, Nogueira RG, Yoo AJ, Jovin TG, Siddiqui AH, Bernard T, Claffey M, Andersson T (2018) Primary results of the multicenter ARISE II study (analysis of revascularization in ischemic stroke with EmboTrap). Stroke. https://doi.org/10.1161/STROKEAHA.117.020125

  21. Kallenberg K, Solymosi L, Taschner CA, Berkefeld J, Schlamann M, Jansen O, Arnold S, Tomandl B, Knauth M, Turowski B (2016) Endovascular stroke therapy with the Aperio thrombectomy device. J Neurointerv Surg. 8(8):834–839

    Article  PubMed  Google Scholar 

  22. Singer OC, Haring HP, Trenkler J, Nolte CH, Bohner G, Reich A, Wiesmann M, Bussmeyer M, Mpotsaris A, Neumann-Haefelin T, Hohmann C, Niederkorn K, Deutschmann H, Stoll A, Bormann A, Jander S, Turowski B, Brenck J, Schlamann MU, Petzold GC, Urbach H, Liebeskind DS, Berkefeld J (2013) Age dependency of successful recanalization in anterior circulation stroke: the ENDOSTROKE study. Cerebrovasc Dis 36:437–445

    Article  PubMed  Google Scholar 

  23. Zaidat OO, Castonguay AC, Gupta R, Sun C-HJ, Martin C, Holloway WE, Mueller-Kronast N, English JD, Linfante I, Dabus G, Malisch TW, Marden FA, Bozorgchami H, Xavier A, Rai AT, Froehler MT, Badruddin A, Nguyen TN, Taqi MA, Abraham MG, Janardhan V, Shaltoni H, Novakovic R, Yoo AJ, Abou-Chebl A, Chen PR, Britz GW, Kaushal R, Nanda A, Issa MA, Nogueira RG (2014) North American solitaire stent retriever acute stroke registry: post-marketing revascularization and clinical outcome results. J Neurointerv Surg. 6(8):584–588

    Article  PubMed  Google Scholar 

  24. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira R, Clark W, Budzik R, Zaidat OO (2014) SWIFT Trialists. SOLITAIRE™ with the intention for thrombectomy (SWIFT) trial: design of a randomized, controlled, multicenter study comparing the SOLITAIRE™ flow restoration device and the MERCI retriever in acute ischaemic stroke. Int J Stroke 9(5):658–668

    Article  CAS  PubMed  Google Scholar 

  25. Stampfl S, Pfaff J, Herweh C, Pham M, Schieber S, Ringleb PA, Bendszus M, Möhlenbruch MA (2017) Combined proximal balloon occlusion and distal aspiration: a new approach to prevent distal embolization during neurothrombectomy. J Neurointerv Surg. 9(4):346–351

    Article  PubMed  Google Scholar 

  26. Maegerlein C, Mönch S, Boeckh-Behrens T, Lehm M, Hedderich DM, Berndt MT, Wunderlich S, Zimmer C, Kaesmacher J, Friedrich B (2018) PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy—evaluation of a double embolic protection approach in endovascular stroke treatment. J Neurointerv Surg 10(8):751–755

    Article  PubMed  Google Scholar 

  27. Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE, Mueller-Kronast N, English JD, Dabus G, Malisch TW, Marden FA, Bozorgchami H, Xavier A, Rai AT, Froehler MT, Badruddin A, Nguyen TN, Asif Taqi M, Abraham MG, Yoo AJ, Janardhan V, Shaltoni H, Novakovic R, Abou-Chebl A, Chen PR, Britz GW, Sun CHJ, Bansal V, Kaushal R, Nanda A, Nogueira RG (2018) First pass effect: a new measure for stroke thrombectomy devices. Stroke. 49(3):660–666

    Article  PubMed  Google Scholar 

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Contributors

All authors contributed to the conception of the work and the acquisition, analysis, and interpretation of data. They edited, revised, and finally approved the manuscript version to be published. They agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BT received personal fees from Acandis outside the submitted work.

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Authors and Affiliations

  1. Medical Faculty, Department of Diagnostic and Interventional Radiology, University Duesseldorf, Moorenstr.5, 40225, Duesseldorf, Germany

    Marius Georg Kaschner, Daniel Weiss, Christian Rubbert, Vivien Ivan, Bastian Kraus, Bernd Turowski & Julian Caspers

  2. Medical Faculty, Department of Neurology, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany

    John-Ih Lee, Michael Gliem & Sebastian Jander

Authors
  1. Marius Georg Kaschner
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  2. Daniel Weiss
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Correspondence to Daniel Weiss.

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The authors declare that they have no conflict of interest.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Patients were informed about the approach, benefit, and risks of the planned procedure in the emergency setting, and informed consent was obtained prior to intervention. Consent for retrospective data analysis was waived.

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The study was approved by the local ethics committees.

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Kaschner, M.G., Weiss, D., Rubbert, C. et al. One-year single-center experience with the Aperio thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome. Neurol Sci 40, 1443–1451 (2019). https://doi.org/10.1007/s10072-019-03861-z

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