• World Neurosurg · Oct 2024

    Optimal catheter selection for acute stroke patients with type III aortic arch based on magnetic resonance angiography road mapping of the para-aortic trans-femoral access route before mechanical thrombectomy.

    • Satoshi Kobayashi, Toshiya Osanai, Noriyuki Fujima, Akiyoshi Hamaguchi, Taku Sugiyama, Toshitaka Nakamura, Kazutoshi Hida, Hiroyuki Itosaka, Yoshimasa Niiya, and Miki Fujimura.
    • Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan; Department of Neurosurgery, Iwamizawa General Hospital, Iwamizawa, Japan.
    • World Neurosurg. 2024 Oct 1; 190: e153e157e153-e157.

    BackgroundAlthough mechanical thrombectomy for acute ischemic stroke has a high recanalization rate, procedurally challenging lesions remain in approximately 10% of the cases. Type III aortic arches, due to their anatomical configuration, are a fundamental problem impacting this procedure. This study aimed to determine whether optimal catheter selection for type III aortic arches, using magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route, reduces the time required for mechanical thrombectomy.MethodsWe retrospectively evaluated 203 consecutive patients who underwent mechanical thrombectomy at multiple centers between April 2018 and July 2022. 23 patients were diagnosed with a type III aortic arch using MRA-based road mapping performed to visualize the para-aortic access route before neuro-interventional procedures. Among the 23 patients with type III aortic arches, 10 received a Simmons-type catheter (initial Simmons group) and 13 received a JB-2-type catheter (initial JB-2 group) as their first inner catheter. The time required for mechanical thrombectomy was compared between the groups.ResultsCompared with the initial JB-2 group, the initial Simmons group exhibited a significantly shorter "puncture-to-recanalization time" (105 vs. 53 minutes, P = 0.009) and "door-to-recanalization time" (164 vs. 129 minutes, P = 0.032).ConclusionsOptimal catheter selection by identifying the aortic arch before mechanical thrombectomy using MRA-based road mapping effectively reduced the mechanical thrombectomy time. This suggests that even in type III aorta cases, appropriate catheter selection may shorten the mechanical thrombectomy time and improve acute ischemic stroke prognosis.Copyright © 2024 Elsevier Inc. All rights reserved.

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