• Daniele Giuseppe Romano, Giulia Frauenfelder, Rosa Napoletano, Annibale Botto, Gianpiero Locatelli, Maria Pia Panza, Alfredo Siani, Salvatore Tartaglione, Emiliano Visconti, and Renato Saponiero.
• Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
• World Neurosurg. 2020 Mar 1; 135: e650-e656.

ObjectiveWe sought to assess preliminary technical and clinical outcomes of Catalyst 5 (CAT 5) as front-line aspiration treatment for M2-M3 occlusion in acute ischemic stroke.MethodsPatients with symptomatic stroke and distal M2 or M3 occlusions were enrolled retrospectively. A direct aspiration first-pass technique was used as the first treatment option for absolute contraindication to intravenous fibrinolytic therapy. Time to recanalization, first attempt recanalization, and number of attempts were recorded. Successful recanalization was defined as a modified thrombolysis in cerebral infarction score ≥2b; incidence of procedure-related complications was recorded. National Institutes of Health Stroke Scale at discharge and modified Rankin Scale score at 90 days were evaluated by a dedicated neurologist.ResultsA total of 11 acute occlusions of distal M2-M3 segment were treated with a direct aspiration first-pass technique using CAT 5 (mean age 69.3 years). Tandem occlusion was present in 2 cases. Intracranial preocclusive mean vessel diameter was 1.9 mm. Overall modified thrombolysis in cerebral infarction score ≥2b was obtained in 72.7% of patients with mean time to recanalization of 36.4 minutes and a mean of 1.9 attempts. First-attempt recanalization with CAT 5 was obtained in 54% of patients with a mean time to recanalization of 29.2 minutes. A stent retriever with proximal aspiration was incorporated as a rescue device in 2 cases. Embolization of new territories was reported after CAT 5 aspiration in 1 patient. No intracranial hemorrhage was detected on follow-up computed tomography. The median National Institutes of Health Stroke Scale score at discharge was 3. At 90 days, a modified Rankin Scale score of 0-2 was achieved in 90.9% of patients.ConclusionsPreliminary experience using CAT 5 in distal occlusions demonstrates that it may be safe and effective in acute stroke treatment.Copyright © 2019 Elsevier Inc. All rights reserved.

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