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J Neurointerv Surg. 2017 Nov;9(11):1103-1106. doi: 10.1136/neurintsurg-2016-012750. Epub 2016 Oct 27.

Initial experience with SOFIA as an intermediate catheter in mechanical thrombectomy for acute ischemic stroke.

Author information

1
Department of Neurosurgery, Stanford University Hospital, Stanford, California, USA.
2
Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA.

Abstract

BACKGROUND:

The benefits of mechanical thrombectomy for emergent large vessel occlusion (ELVO) have been established. Combined mechanical/aspiration (Solumbra) and a direct aspiration as a first pass technique (ADAPT) are valid procedures requiring an intermediate catheter for clot suction. Recently, SOFIA (Soft torqueable catheter Optimized For Intracranial Access) was developed as a single lumen flexible catheter with coil and braid reinforcement, but its suitability for mechanical thrombectomy had not been evaluated.

OBJECTIVE:

To describe our initial experience with SOFIA in acute stroke intervention and evaluate its efficacy and safety.

METHODS:

All patients with ELVO undergoing endovascular stroke intervention with SOFIA were identified. Demographic, presentation, treatment, and complication data were recorded. Primary outcome was Thrombolysis in Cerebral Infarction (TICI) 2b/3 revascularization rate and the number of passes required. Secondary outcomes included complication rates and discharge National Institute of Health Stroke Scale (NIHSS) score.

RESULTS:

33 patients with a mean age of 72 years were treated for ELVO with SOFIA and IV tissue plasminogen activator was administered in 67%. Vessel occlusion involved the internal carotid artery (15.2%), M1 (48.5%), and M2 (24.2%) segments, and posterior circulation (12.1%). Median presentation NIHSS score was 14 (IQR 11-19) and discharge NIHSS 4 (IQR 2-14). The Solumbra technique represented 94% of treatments and ADAPT 3%. The TICI 2b/3 revascularization rate was 94%, including 48.5% TICI 3 with an average of 1.6 passes. The symptomatic reperfusion hemorrhage rate was 6%. Procedural complications occurred in four patients, but were unrelated to SOFIA. Mortality was 21%, secondary to failed revascularization, hemorrhagic transformation, and baseline medical condition.

CONCLUSIONS:

Mechanical and aspiration thrombectomy with SOFIA is safe and effective with high revascularization rates. Its trackability, stability, and luminal size make SOFIA suitable for stroke intervention.

KEYWORDS:

Catheter; Intervention; Stroke; Technology; Thrombectomy

PMID:
27789787
DOI:
10.1136/neurintsurg-2016-012750
[Indexed for MEDLINE]

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