Unlocking the Potential of First Pass Efficacy in Stroke Thrombectomy

When it comes to stroke care, time is brain. Every minute lost equates to millions of neurons dying, and the repercussions on a patient's quality of life can be profound. In the pursuit of minimizing these neurological deficits, innovations in stroke thrombectomy devices and techniques are paramount. Among these, the concept of First Pass Efficacy (FPE) and the integration of cyclic aspiration hold significant promise.

FPE, simply put, refers to the successful achievement of optimal reperfusion outcomes in a single pass during mechanical thrombectomy. It's a critical metric because it directly influences patient outcomes, reducing the time taken to restore blood flow to the ischemic brain tissue. In recent years, researchers have delved into the potential of the aspiration source to enhance FPE. The exploration of non-continuous aspiration presents a novel approach to improve the efficiency of aspiration thrombectomy.

A recent prospective, multicenter study compared the safety and efficacy of a novel cyclic aspiration system with contemporary controls. The primary endpoint of this study was the rate of achieving modified Thrombolysis in Cerebral Infarction (mTICI) score of 2c or higher after the first pass. The results were promising. In the intent-to-treat population, the rate of mTICI ≥ 2c after the first pass was significantly higher in the cyclic aspiration pump arm compared to the control arm, demonstrating the potential of this technology to improve FPE rates.

Moreover, functional independence at 90 days post-procedure, measured by a modified Rankin Scale (mRS) score of 0-2, was notably higher in the cyclic aspiration pump arm compared to the control arm. Importantly, the study reported no symptomatic intracranial hemorrhages within 24 hours post-procedure in the cyclic aspiration pump arm, highlighting its safety profile.

The success of this small study underscores the importance of integrating cyclic aspiration into stroke thrombectomy. Cyclic aspiration operates on the principle of delivering high-frequency pulsed vacuum forces, enhancing the efficiency of thrombus removal. By oscillating between aspiration and relaxation phases, cyclic aspiration optimizes clot engagement and removal, potentially improving recanalization rates and patient outcomes.

The implications of these findings are profound. Achieving FPE not only reduces procedural time but also minimizes the risk of embolization and distal migration of thrombi, which can lead to re-occlusion and worsen patient outcomes. Furthermore, the safety profile demonstrated by cyclic aspiration offers reassurance to clinicians, paving the way for wider adoption of this technology.

As with any novel intervention, further research is warranted to validate these preliminary findings and evaluate the long-term benefits of cyclic aspiration in stroke thrombectomy. Additionally, efforts should be directed towards refining patient selection criteria and optimizing procedural techniques to maximize the potential of FPE and cyclic aspiration in improving stroke outcomes.

The integration of cyclic aspiration represents a significant stride forward in the management of acute ischemic stroke. We believe innovative technologies like cyclic aspiration has transformative potential in stroke care. As we continue to unravel the complexities of stroke pathophysiology, embracing these advancements will undoubtedly play a pivotal role in reshaping the landscape of stroke management and improving patient outcomes.

Reference: Bajrami A, Geyik S, Ertugrul O, et al. Rapidpulse cyclic aspiration system for acute ischemic stroke due to large vessel occlusions. Interventional Neuroradiology. 2024;0(0). doi:10.1177/15910199241239094