With you all the way
improved patient outcomes, and without any additional complications.” When using a larger-bore aspiration catheter such as AXS Vecta, Spiotta says there are several important considerations to be made. The first is to choose the access strategically. “Femoral artery access has
Slingshot technique
been the mainstay of treatment, but recently the radial artery has become an option,” he notes. Additionally, he says that, when
Guiding principles What are the important considerations when selecting guidewires for ischaemic and haemorrhagic treatments? This is among the topics discussed by Brian Jankowitz (Cooper Neurological Institute, Camden, USA), who details why he favours the use of Synchro (Stryker) guidewires, and discusses new developments with the latest iteration of the device.
Why do you choose to use Synchro Guidewires?
I like Synchro because, for me, it is consistently excellent. I am never surprised by the utility or function of that wire. I can always predict how it is going to function or react, in even the most torturous or complex anatomy. From pushability, trackability, tipshape retention, proximal support or distal softness profile, I think it hits the mark on every one of those variables. September 2021
delivering the aspiration catheter, sufficient and it has shown great benefit to patients.” guide support is needed, and he highlights For thrombectomy procedures, Spiotta the importance of minimising the ledge effect considers that the most important measure of the aspiration catheter, which hinders of success is the time to recanalisation. successful neurointervention. Once “The most important thing is how the microcatheter and microwire fast we can get the artery open,” are delivered to the thrombus, he comments. Further to this is they are gently pulled back as the the extent of the recanalisation. aspiration catheter is advanced. “In years prior, the endpoint was This allows the aspiration catheter achieving a recanalisation of to take the inside turns across greater than 50% of the territory. arterial tortuosity and aids in its The techniques have gotten better. delivery. This ‘slingshot’ technique We have gotten faster and safer. allows the aspiration catheter to Alejandro Spiotta Now, we are really aiming for travel over the thrombus, thereby 90‒100% of the territory being ingesting it. Once the aspiration force is restored,” he adds. applied to the catheter, clot retrieval is As direct aspiration thrombectomy achieved. AXS Vecta works well from both continues its rapid evolution, centres like radial and femoral approaches, Spiotta says, MUSC will be at the forefront of research adding that it is “a case of picking the right into how the refinement of the technique approach for the right patient”. and new iterations of catheters will As the number of passes required to open influence outcomes. Spiotta believes that the vessel reduces, the requirement of going research including the ASSIST and STAR to a secondary modality or a bailout strategy registries will be fundamental to the future like a stentriever has gone down, Spiotta of stroke care. “It is very important that we adds, contributing to savings in both time are continuously evaluating our path, our and cost. “We think these improvements, outcomes, and comparing techniques to each which are in the order of minutes, do matter other,” he says, “It is a rapidly evolving field, for these patients that are having a stroke, so as new techniques and new developments because, as you know, in our philosophy, come about, as they naturally will, it is every minute counts. It has really been an critical that we continuously self-evaluate as evolution of the ADAPT technique over time we go along.”
What difference have you noticed between the Synchro2 and the new Synchro SELECT Guidewire?
It is very difficult to improve upon perfection. Brian Jankowitz The classic Synchro2 wire is excellent. The most tangible benefit to Synchro SELECT is probably the shape retention at the tip. The most important thing about these wires is that they have maintained, from my perspective, every other significant benefit that I have grown to love about Synchro— every aspect that I expect and rely on because it is consistency that is key.
Given the range of devices on the market, what makes you return to the Synchro Guidewire?
I have always loved to speak knowledgeably about products, so I always attempt to try every new competitor device on the market at least once or twice. I am always looking for a new gold standard, and I will jump on the best product on the market, any given day.
*Shaped distal end is subjected to 20 rotations within a tortuous pathway and then remeasured to calculate tip shape loss
I recall a case when I tried a competitor wire and it did not perform as I expected. I could not categorise the aneurysm in a safe and controlled way that I am used to with my standard Synchro or Synchro SELECT. So, I did the best possible comparison—a headto-head in vivo attempt at using a competitor wire, which did not work, and then re-access with the Synchro SELECT wire, which enabled me to safely, smoothly, categorise the same aneurysm events, and micro catheter into it and successfully coil it. Copyright © 2021 Stryker AP-003473 v1.0
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