title: Initial experience using the 3MAX cerebral reperfusion catheter in the endovascular treatment of acute ischemic stroke of distal arteries.
abstract: BACKGROUND
  The advancement of technology has allowed the development of new catheters that may provide safe intracranial navigation.
  
  
  OBJECTIVE
  To report our first experience with the direct aspiration first pass technique in small arteries as the primary method for recanalization with the Penumbra 3MAX cerebral reperfusion catheter.
  
  
  METHODS
  A retrospective case series analysis study of patients with acute ischemic stroke endovascularly treated with the direct aspiration technique using the 3MAX reperfusion catheter in our hospital in the past year.
  
  
  RESULTS
  We treated six patients in our hospital for acute ischemic stroke using the 3MAX aspiration catheter as first choice. The patients had a median National Institutes of Health Strokes Scale (NIHSS) score of 12 (range 10-17) at admission, with occlusions of an M2 segment of a middle cerebral artery (MCA) treated through an anterior communicating artery, pericallosal artery, P2 artery, and M2-MCA and M3-MCA arteries. Recanalization (TICI 2b-3) was achieved in all cases and no complications occurred. It was not necessary to combine treatment with a stent retriever in any of the patients. All the patients showed early neurological improvement. The median NIHSS score at discharge was 1 (0-3) and 5/6 (83%) patients had a modified Rankin Scale score 0-2 at discharge.
  
  
  CONCLUSIONS
  Our initial experience suggests that treatment of distal cerebrovascular occlusions with the 3MAX catheter is feasible. We achieved complete recanalization in all cases without unexpected complications while obtaining good clinical results. However, larger studies are necessary to establish its benefits and its safety.
authors.affiliation: Department of Radiology-Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: Pedro
authors.identifier: http://orcid.org/0000-0002-6516-6090
authors.initials: P
authors.lastname: Navia
authors.affiliation: Department of Radiology-Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: Jose-Angel
authors.initials: JA
authors.lastname: Larrea
authors.affiliation: Department of Radiology-Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: Edurne
authors.initials: E
authors.lastname: Pardo
authors.affiliation: Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Arce
authors.affiliation: Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Martínez-Zabaleta
authors.affiliation: Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: Noemí
authors.initials: N
authors.lastname: Díez-González
authors.affiliation: Department of Radiology-Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Murias
authors.affiliation: Faculty of Medicine, Department of Human Anatomy and Embryology, Madrid Complutense University, Madrid, Spain.
authors.forename: Luis-Alfonso
authors.initials: LA
authors.lastname: Arráez-Aybar
authors.affiliation: Department of Radiology-Neuroradiology, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Massó
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000601:surgery*; D062905:Central Venous Catheters; D002533:Cerebral Angiography; D002536:Cerebral Arteries; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015424:Reperfusion / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000601:surgery*; D013396:Suction / Q000379:methods; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Catheter; Stroke; Technique; Thrombectomy