title: Ultra-distal access of the M1 segment with the 5 Fr Navien distal access catheter in acute (anterior circulation) stroke: is it safe and efficient?
abstract: OBJECTIVE
  The importance of mechanical thrombectomy in acute stroke treatment has grown over recent years. Mechanical thrombectomy comprises many different techniques. Technical improvements in the catheter material have led to the development of large-bore distal access catheters which can enter tortuous intracranial vessels. This has promising applications for endovascular stroke treatment. This study evaluated the safety and success rate of ultra-distal access of the middle cerebral artery (MCA) M1 segment with the 5 Fr Navien 58 distal access catheter in the treatment of acute stroke in combination with stent retrievers.
  
  
  METHODS
  We retrospectively analyzed 81 patients with an acute stroke of the anterior circulation in whom ultra-distal access to the M1 segment was carried out using the Navien 58 catheter with an anchoring technique with a stent retriever for mechanical thrombectomy. Technical complications, success rates of catheter placement, success rates of thrombectomy using the modified Thrombolysis In Cerebral Infarction (mTICI) score, and the procedure times were evaluated.
  
  
  RESULTS
  Ultra-distal access with the Navien 58 was successful in 75% (61/81) of cases. Recanalization success with a mTICI score of 2b and better was achieved in 83% overall (67/81), in 90% (55/61) of cases with successful ultra-distal access and in 60% (12/20) of cases without ultra-distal access. No severe adverse effects such as dissections or perforations occurred as a result of the ultra-distal catheter placement in the M1 segment. In 4% (3/81) of the cases a reversible MCA vasospasm occurred.
  
  
  CONCLUSIONS
  Ultra-distal placement of the Navien 58 distal access catheter into the M1 segment in acute anterior circulation stroke can be achieved consistently, is safe in practice, and results in good recanalization success rates.
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Janssen
authors.affiliation: Department of Neurology/Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Killer-Oberpfalzer
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Patzig
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Buchholz
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Lutz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D057785:Catheters / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Catheter; Stroke; Thrombectomy