title: Initial experience with SOFIA as an intermediate catheter in mechanical thrombectomy for acute ischemic stroke.
abstract: BACKGROUND
  The benefits of mechanical thrombectomy for emergent large vessel occlusion (ELVO) have been established. Combined mechanical/aspiration (Solumbra) and a direct aspiration as a first pass technique (ADAPT) are valid procedures requiring an intermediate catheter for clot suction. Recently, SOFIA (Soft torqueable catheter Optimized For Intracranial Access) was developed as a single lumen flexible catheter with coil and braid reinforcement, but its suitability for mechanical thrombectomy had not been evaluated.
  
  
  OBJECTIVE
  To describe our initial experience with SOFIA in acute stroke intervention and evaluate its efficacy and safety.
  
  
  METHODS
  All patients with ELVO undergoing endovascular stroke intervention with SOFIA were identified. Demographic, presentation, treatment, and complication data were recorded. Primary outcome was Thrombolysis in Cerebral Infarction (TICI) 2b/3 revascularization rate and the number of passes required. Secondary outcomes included complication rates and discharge National Institute of Health Stroke Scale (NIHSS) score.
  
  
  RESULTS
  33 patients with a mean age of 72 years were treated for ELVO with SOFIA and IV tissue plasminogen activator was administered in 67%. Vessel occlusion involved the internal carotid artery (15.2%), M1 (48.5%), and M2 (24.2%) segments, and posterior circulation (12.1%). Median presentation NIHSS score was 14 (IQR 11-19) and discharge NIHSS 4 (IQR 2-14). The Solumbra technique represented 94% of treatments and ADAPT 3%. The TICI 2b/3 revascularization rate was 94%, including 48.5% TICI 3 with an average of 1.6 passes. The symptomatic reperfusion hemorrhage rate was 6%. Procedural complications occurred in four patients, but were unrelated to SOFIA. Mortality was 21%, secondary to failed revascularization, hemorrhagic transformation, and baseline medical condition.
  
  
  CONCLUSIONS
  Mechanical and aspiration thrombectomy with SOFIA is safe and effective with high revascularization rates. Its trackability, stability, and luminal size make SOFIA suitable for stroke intervention.
authors: Department of Neurosurgery, Stanford University Hospital, Stanford, California, USA.
authors: Johnny H Y
authors: JHY
authors: Wong
authors: Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA.
authors: Huy M
authors: HM
authors: Do
authors: Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA.
authors: Nicholas A
authors: NA
authors: Telischak
authors: Department of Neurosurgery, Stanford University Hospital, Stanford, California, USA.
authors: Adrienne M
authors: AM
authors: Moraff
authors: Department of Neurosurgery, Stanford University Hospital, Stanford, California, USA.
authors: Robert L
authors: RL
authors: Dodd
authors: Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA.
authors: Michael P
authors: MP
authors: Marks
authors: Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA.
authors: Shreya M
authors: SM
authors: Ingle
authors: Department of Radiology, Interventional Neuroradiology Division, Stanford University Hospital, Stanford, California, USA.
authors: Jeremy J
authors: http://orcid.org/0000-0003-1055-8000
authors: JJ
authors: Heit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery*; D057785:Catheters; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D061185:Mechanical Thrombolysis / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Catheter; Intervention; Stroke; Technology; Thrombectomy