Thomas Liebig (Berlin, Germany) reported that a first-line aspiration approach with MicroVention’s Sofia (soft torqueable catheter optimised for intracranial access) device is “worth a try” because it is associated with similar results to first-line aspiration approaches with other dedicated intermediate catheters, and unsuccessful aspiration with Sofia can be “easily converted” into stent retriever-based therapy.
Speaking at the annual meeting of the European Society of Minimally Invasive Neurological Therapy (ESMINT; 10–12 September, Nice, France), Liebig (Department of Neuroradiology, Charité, Berlin, Germany) reported that he and his colleagues recently published (in the Journal of Neurointerventional Surgery) their initial experience of using Sofia—a novel distal access and aspiration device—for management of acute ischaemic stroke. He noted that of the 115 patients in the retrospective study, 22 underwent a first-line aspiration approach and, since its publication, an additional eight patients had undergone a first-line aspiration approach with the device. Therefore, in his presentation at ESMINT, Liebig focussed on the outcomes of all 30 patients who had been treated with first-line aspiration approach.
To be eligible for treatment with the Sofia device, all patients had to have a documented large vessel occlusion, an Alberta stroke programme early CT score (ASPECTS) score of 7–10, a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≥5, and symptom onset of less than eight hours (if salvageable tissue present). Patients were excluded if they had an intracranial haemorrhage. Liebig explained that, using a standard 8/6Fr guide catheter, “the Sofia device was advanced to the level of occlusion, over a .035” Terumo, a 0.14” microguidewire or by itself in selected cases, and manual aspiration was performed with a regular 20cc syringe and maintained for 2-3 min., but at least one minute.” He added that if aspiration failed (ie. did not achieve the required level of recanalisation), the procedure was repeated up to three times and if the third attempt failed, the procedure was converted into a “standard stent retrieval (Solitaire, Trevo) procedure (rescue therapy)”.
Among the 30 patients who underwent the first-line aspiration approach, all lesions could be reached with very limited effort. Overall, successful recanalisation (mTICI score of ≥2b) was achieved in 90% of patients. Only nine patients required rescue therapy to achieve the final mTICI score—meaning that successful recanalisation was achieved with aspiration alone in two thirds of patients. Liebig reported that among patients who achieved successful recanalisation with aspiration alone, the average number of aspiration attempts was 1.4±0.7. He added that 62% of the aspiration alone patients had an mTICI score of ≥3 (compared with 44% of rescue patients) and that “half of these patients only required a single attempt.” Furthermore, patients with middle cerebral artery occlusions (17 patients in the study) seemed to be “especially suitable” to undergoing a first-line aspiration approach because “seven out of 10 first pass successes were in middle cerebral artery occlusions.”
Liebig also noted that the average “groin to recanalisation” time with aspiration alone was “20 minutes” vs. 40 minutes with rescue therapy and that there no procedural adverse events apart from one intracranial haemorrhage a patient who received rescue therapy. He added: “Good outcome was associated with age (p=0.03), initial NIHSS score (p=0.0008) and time to recanalisation (p=0.04). Clot length and use of intravenous thrombolysis had no impact on success, duration of treatment and clinical outcome.”
Concluding, Liebig said: “First-line lesion aspiration with the Sofia is in line with previously published data for dedicated intermediate catheters; application is easy and there were no safety issues in our series; and fast aspiration-only recanalisaiton is possible, particularly in the middle cerebral artery. Therefore, first-line aspiration with the Sofia device is worth a try because even if unsuccessful, it easily converts into part of a stent-retriever based multimodal treatment.”