Project Grant R41NS122602

ENABLING RAPID AND EFFECTIVE STROKE THROMBECTOMY PROCEDURES FROM A TRANSRADIAL APPROACH: COMBINING INTRODUCER SHEATH, GUIDE CATHETER, AND DISTAL ACCESS CATHETER INTO A SINGLE DEVICE. - PROJECT SUMMARY/ABSTRACT THIS PROPOSAL'S LONG-TERM GOAL IS TO IMPROVE THE CARE OF PATIENTS SUFFERING FROM LARGE VESSEL OCCLUSION ACUTE ISCHEMIC STROKE (LVO AIS). EMERGENT, CATHETER-BASED THROMBECTOMY IS AN ESTABLISHED TREATMENT FOR LVO AIS. STILL, SUBSTANTIAL LIMITATIONS REMAIN. RAPID CATHETERIZATION OF DISTAL, INTRACRANIAL VESSELS REPRESENTS AN ESSENTIAL FEATURE OF SUCCESSFUL THROMBECTOMY PROCEDURES. GIVEN THE ADVANCED AGE OF MANY OR MOST THROMBECTOMY CANDIDATES, HIGHLY TORTUOUS VESSELS ARE FREQUENTLY ENCOUNTERED WHEN TRAVERSING FROM THE FEMORAL TO CAROTID TERRITORIES. IT HAS BEEN SHOWN THAT SUBSTANTIAL TORTUOSITY LEADS TO WORSE OUTCOMES IN TRANSFEMORAL THROMBECTOMY PROCEDURES. THUS, MANY LEADING INTERVENTIONALISTS HAVE PROPOSED TRANSRADIAL ACCESS (TRA) IN PLACE OF TRANSFEMORAL ACCESS. WITHIN INTERVENTIONAL CARDIOLOGY, TRA IS THE PREFERRED ACCESS SITE FOR THE VAST MAJORITY OF PATIENTS, GIVEN LOW RATES OF BLEEDING COMPLICATIONS AND READY ACCESS TO THE CORONARY CIRCULATION. THE RADIAL SITE ALSO PROVIDES READY ACCESS TO THE CEREBRAL VASCULATURE, BYPASSING TORTUOSITY ALONG THE AORTIC ARCH, DESCENDING AORTA, AND ILIO-FEMORAL SYSTEM. MANY NEUROINTERVENTIONALISTS HAVE EMBRACED TRA FOR DIAGNOSTIC PROCEDURES. HOWEVER, EVEN THOUGH TRA WOULD PROVIDE SUBSTANTIALLY EASIER ACCESS THAN TRANSFEMORAL ACCESS FOR THROMBECTOMY PROCEDURES IN PATIENTS WITH SUBSTANTIAL TORTUOSITY, FEW PRACTITIONERS USE TRA FOR TREATMENT FOR THESE PATIENTS. THE PRIMARY IMPEDIMENT TO EXPANSION OF TRA THROMBECTOMY RELATES TO AN ONGOING DEARTH OF RADIAL-SPECIFIC ACCESS AND INTERVENTIONAL TOOLS, WHICH MUST BE CUSTOMIZED TO THE SMALL DIAMETER OF THE RADIAL ARTERY AS WELL AS THE SPECIFIC GEOMETRIC CHALLENGES IN NAVIGATING FROM THE SUBCLAVIAN TO CAROTID TERRITORIES. IN THIS PHASE 1 STTR PROGRAM, WE WILL DEVELOP AND TEST A NOVEL LARGE-BORE THROMBECTOMY SYSTEM APPROPRIATE FOR TRA. SPECIFICALLY, OUR WRIST-TO-BRAIN THROMBECTOMY SYSTEM IS A 3-IN-1 DEVICE THAT COMBINES ACCESS SHEATH, GUIDING CATHETER, AND DISTAL ACCESS CATHETER IN TO A SINGLE DEVICE. THIS INNOVATION WILL REQUIRE SPECIFIC ADVANCES IN DIRECT ARTERIAL ACCESS, KINK RESISTANCE, AND DISTAL SUPPLENESS. IF SUCCESSFUL, OUR W2B THROMBECTOMY SYSTEM WILL ENHANCE CARE OF ELDERLY PATIENTS WITH HIGHLY TORTUOUS VASCULATURE WHO PRESENT WITH LVO AIS.