Distal vessel aspiration in acute ischaemic stroke using the RED 43 aspiration catheter (DIVA study): An international multicentre experience

Abstract

Background

For medium vessel occlusions (MeVOs), in acute ischaemic stroke (AIS), the clinical efficacy of mechanical thrombectomy (MT) is the topic of ongoing randomised clinical trials, and the optimal recanalisation technique remains undetermined. We aim to assess the effectiveness and safety of the novel RED 43 distal reperfusion catheter for the treatment of MeVOs.

Methods

We retrospectively reviewed consecutive cases of anterior and posterior circulation MT for MeVO where the RED 43 aspiration catheter was used at four comprehensive stroke centres in Australia and United Kingdom, from April 2023 to June 2024. Procedural outcomes (navigation to the target vessel, final near complete-complete recanalisation (extended Thrombolysis in Cerebral Infarction (eTICI) 2c-3) and single-pass eTICI 2c-3 (first-pass effect (FPE)), 90-day modified Rankin score, safety and procedural complications (haemorrhagic, vessel dissection or perforation) were analysed.

Results

Seventy-four patients were included (median age 72.8 years [SD 13.1]; 33.8% females). Median baseline NIHSS was 10 [iQR 5–15], and median ASPECTS was 9. Primary MeVOs (without large vessel occlusion) accounted for 58.1% of cases. The occlusion site was reached using the RED 43 in 100% of cases. In particular, the target was reached navigating the catheter over a microwire only in 83.8% of cases. Fifty-seven (77%) patients achieved final eTICI 2c-3 and the FPE (eTICI 2c-3) for the RED 43 was 60.8%. Modified Rankin Scale (mRS) ≤ 2 at 90-days was 67.1%. No intraprocedural complications were recorded. Symptomatic intracranial haemorrhage and 90-day mortality rates were 4.1% and 19%, respectively.

Conclusion

The novel RED 43 distal aspiration catheter was shown to be safe and effective in achieving good technical and clinical outcomes amongst acute stroke patients presenting with MeVO. If MT for MeVO is proven to be efficacious, future studies should aim to compare available MT techniques in achieving fast and complete vessel recanalisation.