Background: Reperfusion of large vessel occlusions in acute stroke can improve patient outcomes. The purposes of this study were to assess the safety and efficacy of the Penumbra 5MAX ACE catheter for revascularization of large vessels and to compare its cost to the cost of stent retrievers.
Methods: In this retrospective, single-center case review study, data were captured on consecutive patients treated with the Penumbra 5MAX ACE as first-line therapy during an 11-month period. Good functional outcome was defined as a modified Rankin Scale score of ≤2 at discharge. Results were directly compared with previously published data for stent retrievers, and length of stay was analyzed in relation to revascularization.
Results: The 31 patients studied had a mean age of 66.3 ± 17.8 years and a mean National Institutes of Health Stroke Scale score of 19.4 ± 5.7. Intravenous tissue recombinant plasminogen activator therapy was initiated in 35.5% (11/31) of patients. A Thrombolysis in Cerebral Infarction (TICI) grade of 2b-3 reperfusion after endovascular therapy was achieved in 26/31 (83.9%) of cases; TICI grade 3 was achieved in 19/31 (61.3%) patients. The average time from groin puncture to TICI grade 2b-3 reperfusion was 40 minutes. The average estimated cost for aspiration with the 5MAX ACE alone was $4,916 per case compared with an estimated cost of $9,620 if a stent retriever was used as the primary device. Our actual average cost per case, including all adjunctive devices used in the neurointerventional procedure, was $6,997. Good functional outcome was achieved in 19/31 (61.3%) patients. Two patients experienced symptomatic intracerebral hemorrhage (6.5%), and 1 (3.2%) patient died. The length of stay was significantly shorter among patients with TICI grade 2b-3 reperfusion compared to patients with TICI grade <2 (6.8 ± 5.34 days vs 15.8 ± 11.32 days, respectively; P<0.05).
Conclusion: These findings suggest that direct aspiration with the large-bore 5MAX ACE catheter can be considered a first-line approach to mechanical thrombectomy for large vessel occlusions. Our results demonstrated high rates of successful reperfusion in a timely manner with excellent clinical outcomes, although our sample size was small. In addition, this direct-aspiration technique has important cost-savings potential compared to stent retrievers.
Keywords: Intracranial thrombosis; ischemia; reperfusion; stroke; thrombectomy.