The RED 43 catheter for aspiration thrombectomy of distal medium vessel occlusions (DMVOs): a multicenter experience

BACKGROUND: Recent studies support the effectiveness of mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs). The RED 43 catheter has been introduced as a primary catheter for distal aspiration in acute ischemic stroke. In this multicenter study, we share our experience of using the RED 43 catheter for MT in DMVOs. METHODS: We identified consecutive patients with DMVOs who underwent primary aspiration thrombectomy using the RED 43 catheter at four high-volume stroke centers. We collected baseline clinical data, angiographic and clinical outcomes, and procedural complications. We divided the patients into two groups: those with primary DMVOs included patients who presented with more distal occlusions requiring mechanical thrombectomy; and those with secondary DMVOs being patients presenting with large vessel occlusion that later developed a DMVO. Primary outcomes included the rate of first pass effect, (modified treatment in cerebral infarction (mTICI) 2c or 3 on the first pass) and successful recanalization (mTICI≥2b at end of procedure). Secondary outcomes included good functional outcomes (modified Rankin Scale (mRS) 0-2 at 3 months), symptomatic intracerebral hemorrhage (sICH), asymptomatic intracerebral hemorrhage (aICH), subarachnoid hemorrhage (SAH), and in-hospital mortality. RESULTS: We identified 102 consecutive DMVO cases undergoing thrombectomy with the RED 43 catheter. The mean age was 70 years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 9. The first pass effect (FPE) rate was 57% (primary) and 61% (secondary). Successful recanalization occurred in 83% (primary) and 87% (secondary). Good functional outcome was observed in 57% of patients. sICH occurred in one patient, and two patients died during hospitalization. We observed aICH in five (4.9%) patients and SAH in seven (6.9%) patients. CONCLUSION: The RED 43 catheter is safe and effective for aspiration thrombectomy in primary and secondary DMVOs, with high recanalization rates and a favorable safety profile.