Maximizing First Pass Effect in Stroke Treatment: A Guide to Technique Selection

Technical Guide for models including:

First Pass Effect最大化を目指すためのテ ...

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Total Stroke Solutions vol. 3
First Pass Effect

UCLA

Acute ischemic stroke: AIS Large vessel occlusion: LVO Mechanical Thrombectomy: MT Stent retriever: SR Aspiration catheter: ACCombined technique SRPinchingSR Ingestion1
First Pass Effect FPE
20-40% symptomatic

Intracranial Hemorrhage: sICH sICH FPE

M1M2

FPE

Stent retriever
1

Aspiration catheter

Pinching

Ingestion

Combined technique

Total Stroke Solutions vol. 3
First Pass Effect

UCLA

ACAC FPE

ACICA AC

M1M2

ICA3mm

AC AXS Vecta 74ID 0.074

ACCatheter ID to Vessel ID RatioCVR / 1.9mmICAAXS Vecta 74

1,2CVR CVR 0.71

CVR0.71 ICAFPE

ASSISTICA

AC7 ACSRCombined technique

FPE3ICA

CTAMRA AC

CVR >0.71ACAXS Vecta /AXS Catalyst

ACCombined techniqueAC

M2AXS

Vecta 46M2 AC

ACCVR

CVR >0.71

AXS Vecta 46

1.2

1.4

AXS Catalyst 6

1.5

1.8

AXS Catalyst 7

1.7

2.1

AXS Vecta 71

1.8

2.1

AXS Vecta 74

1.9

2.1

mm
1.4 1.7 1.8 2.1 2.1 2.4 2.1 2.5 2.1 2.6

Total Stroke Solutions vol. 3
First Pass Effect

UCLA

MT IngestionSR

48SR PinchingGuiding catheter

SR Ingestion technique

sICHSR

M2P2

Distal Medium Vessel

Occlusion (DMVO) 20252

DMVOMT AC

RCTDISTAL, ESCAPE MeVO, DISCOUNT SR

MT AC

MTsICH911 Ingestion Combined technique

DMVO IngestionSRAC

MT AC

AC Pinching Combined technique

Angle of Interaction: SR

AOI

7SRAC

SRSRPinching

in vitro 2

SRPinching

mN 100

0 Stent only

Pinching

Ingestion

AXS Catalyst 6, Trevo 3x32, n=5

Total Stroke Solutions vol. 3
First Pass Effect

UCLA

3PinchingDDS

Combined techniqueSRAC Pinching techniqueICA 12 Difference in Device Slacks DDS
SR AC SRAC DDS SRACPinching ACSR SRAC SRAC SRAC ACSRAC SRACAC 3
SRAC S RA C D D S

Pinching in vitroDDSSlack+2cm +4cm4mmFragment 4 D i s t a l EmbolizationFPE /SRAC SRDDS AC
A

3 Pinching techniqueDDS SRADDS ACSRAC ACBDDS SRAC

B
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

DDS Fragment 4mm P=0.038

Slack 0

Slack 2

Slack 4

4 DDSClot fragmentationA ICABACSR 4cmDDS 4cmAC Clot fragmentation

Total Stroke Solutions vol. 3
First Pass Effect

UCLA

Pinching technique ACTrevo NXT

ACDDSSR SR

AC SRAC

ACSR

Pinching technique

ACDDSTrevo DDSAC

N X T

PinchingDDS FPE

M12.1mmACAXS Catalyst 7

Trevo NXT 4x41mmM1-M2

NIHSS 24CTA LVO

Right M1 occlusion

ACDDS

CTAM12.1mmM1 Pinching technique1st Pass

eTICI 3CT

ACPinching technique

AM12.1mmCAT 7

BM1-M2Pinching technique

CTrevo NXT 4x41mm

DPinching1eTICI 3

Total Stroke Solutions vol. 3
First Pass Effect

UCLA

FPE
3 1 2Pinching 3

AXS Vecta / AXS Catalyst Trevo NXT Retriever FPE

1. Kyselyova AA, Fiehler J, Leischner H, et al. Vessel diameter and catheterto-vessel ratio affect the success rate of clot aspiration. J Neurointerv Surg 2021; 13: 605608.
2. Charbonnier G, Primikiris P, Desmarets M, et al. Defining the optimal size of an aspiration catheter in relation to the arterial diameter during mechanical thrombectomy for stroke. J Neuroradiol. Epub ahead of print February 3, 2023. DOI: 10.1016/j.neurad.2023.01.158.
3. Neuberger U, Price LL, Miralbés S, et al. Clinical impact of reperfusion techniques and occlusion sites in thrombectomy: Insights from the ASSIST stroke registry. Stroke Vasc Interv Neurol; 4. Epub ahead of print November 2024. DOI: 10.1161/svin.124.001446.
4. Schwaiger BJ, Gersing AS, Zimmer C, et al. The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke. AJNR Am J Neuroradiol 2015; 36: 971976.
5. Yamamoto S, Yamagami H, Todo K, et al. Correlation of middle cerebral artery tortuosity with successful recanalization using the Merci retrieval system with or without adjunctive treatments. Neurol Med Chir 2014; 54: 113119.
6. Saber H, Colby GP, Mueller-Kronast N, et al. Arterial Tortuosity Is a Potent Determinant of Safety in Endovascular Therapy for Acute Ischemic Stroke. Stroke: Vascular and Interventional Neurology 2024; 4: e001178.

7. Bernava G, Rosi A, Boto J, et al. Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot. J Neurointerv Surg 2020; 12: 396400.
8. Kaneko N, Komuro Y, Yokota H, et al. Stent retrievers with segmented design improve the efficacy of thrombectomy in tortuous vessels. J Neurointerv Surg 2019; 11: 119122.
9. Psychogios M, Brehm A, Ribo M, et al. Endovascular treatment for stroke due to occlusion of medium or distal vessels. N Engl J Med. Epub ahead of print February 5, 2025. DOI: 10.1056/NEJMoa2408954.
10. Goyal M, Ospel JM, Ganesh A, et al. Endovascular treatment of stroke due to medium-vessel occlusion. N Engl J Med. Epub ahead of print February 5, 2025. DOI: 10.1056/NEJMoa2411668.
11. Mocco J. Medium- and distal-vessel occlusion - the limit of thrombectomy? N Engl J Med. Epub ahead of print February 5, 2025. DOI: 10.1056/ NEJMe2500492.
12. Mehta T, Male S, Quinn C, et al. Institutional and provider variations for mechanical thrombectomy in the treatment of acute ischemic stroke: a survey analysis. J Neurointerv Surg 2019; 11: 884890.

All Photographs taken by the Ronald Reagan UCLA Medical Center. Results from case studies are not predictive of results in other cases. Results in other cases may vary.

21 AXS Catalyst

22600BZX00166000 30200BZX00164000 30100BZX00018000

AXS Vecta 46 AXS Vecta

30400BZX00154000 30400BZX00120000

Japan

Stryker or its affiliated entities own, use, or have applied for the following trademarks or service marks: AXS Catalyst, AXS Vecta, Stryker, Trevo NXT, Trevo Trak. All other trademarks are trademarks of their respective owners or holders.
The absence of a product, feature, or service name, or logo from this list does not constitute a waiver of Strykerîs trademark or other intellectual property rights concerning that name or logo.
Literature Number: 2507/00000/W KM/CO W 0725

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