Deans' stroke musings: Walrus large bore guide catheter impact on recanalization first pass effect and outcomes: the WICkED study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, April 15, 2021

Walrus large bore guide catheter impact on recanalization first pass effect and outcomes: the WICkED study

With no reporting on 100% recovery you can't tell how good this is. Recanalization is an intermediate step that survivors don't give a shit about. Your reference to functional independence is just using your fucking tyranny of low expectations to justify failure.

Walrus large bore guide catheter impact on recanalization first pass effect and outcomes: the WICkED study

Gustavo M Cortez1,2,
Raymond D Turner3,
http://orcid.org/0000-0001-6827-6650Andre Monteiro4,
Ajit S Puri5,
http://orcid.org/0000-0002-9519-0059Adnan H Siddiqui4,
http://orcid.org/0000-0001-5489-2524J Mocco6,
http://orcid.org/0000-0001-7164-1479Jan Vargas3,
Anna L Kuhn5,
Shahram Majidi6,
M Imran Chaudry3,
http://orcid.org/0000-0002-9126-2932Amin Aghaebrahim1,
Aquilla S Turk3,
Eric Sauvageau1,
http://orcid.org/0000-0001-7195-5806Ricardo A Hanel1

Correspondence to Dr Ricardo A Hanel, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA; rhanel@lyerlyneuro.com

Abstract

Background The use of a balloon-guide catheter (BGC) in acute stroke treatment has been widely adopted after demonstrating optimized procedure metrics and outcomes. Initial technical constraints of previous devices included catheter stiffness and smaller inner diameters. We aim to evaluate the performance and safety of the Walrus BGC, a variable stiffness catheter with a large bore 0.087 inch inner diameter (ID), via the the WICkED study (Walrus Large Bore guide Catheter Impact on reCanalization first pass Effect anD outcomes).

Methods This is a retrospective, site adjudicated, multicenter study on consecutive patients with large vessel occlusion treated with the Walrus BGC. Baseline characteristics, procedural outcomes and functional outcomes were analyzed.

Results A total of 338 patients met the inclusion criteria. The Walrus was successfully tracked into distal vasculature and allowed therapeutic device delivery in all but 3 cases (0.9%). Large aspiration catheters ≥0.070 inch ID were used in 71.9% of cases. Stent retriever thrombectomy was used as the first-line modality in 59.2% and thromboaspiration in 40.8% of cases. The successful recanalization rate (modified treatment in cerebral ischemia (mTICI) 2b/3) was 94.4%, with 64.8% of the patients achieving mTICI 2b/3 after the first pass. The Walrus-related adverse event rate was 0.6%, corresponding to two vessel dissections. Functional independence was 50% (126/252) and mortality 25% (63/252). Unfavorable outcomes were more likely in older patients, who had unsuccessful reperfusion, longer procedure times, and a higher mean number of passes.

Conclusion In acute ischemic stroke patients presenting with large vessel occlusion, the Walrus BGC demonstrated excellent navigability and safety profile, allowed the accommodation of leading large bore aspiration catheters, and demonstrated high vessel recanalization rates.