Synchro SELECT Guidewire:

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 delivering the aspiration catheter, sufficient guide support is needed, and he highlights the importance of minimising the ledge effect of the aspiration catheter, which hinders successful neurointervention. Once the microcatheter and microwire are delivered to the thrombus, they are gently pulled back as the aspiration catheter is advanced. This allows the aspiration catheter to take the inside turns across arterial tortuosity and aids in its delivery. This ‘slingshot’ technique allows the aspiration catheter to travel over the thrombus, thereby ingesting it. Once the aspiration force is applied to the catheter, clot retrieval is achieved. AXS Vecta works well from both radial and femoral approaches, Spiotta says, adding that it is “a case of picking the right approach for the right patient”.

As the number of passes required to open the vessel reduces, the requirement of going to a secondary modality or a bailout strategy like a stentriever has gone down, Spiotta adds, contributing to savings in both time and cost. “We think these improvements, which are in the order of minutes, do matter for these patients that are having a stroke, because, as you know, in our philosophy, every minute counts. It has really been an evolution of the ADAPT technique over time

and it has shown great benefit to patients.” For thrombectomy procedures, Spiotta considers that the most important measure of success is the time to recanalisation. “The most important thing is how fast we can get the artery open,” he comments. Further to this is the extent of the recanalisation. “In years prior, the endpoint was achieving a recanalisation of greater than 50% of the territory. The techniques have gotten better. We have gotten faster and safer. Alejandro Spiotta Now, we are really aiming for 90‒100% of the territory being restored,” he adds. As direct aspiration thrombectomy continues its rapid evolution, centres like MUSC will be at the forefront of research into how the refinement of the technique and new iterations of catheters will influence outcomes. Spiotta believes that research including the ASSIST and STAR registries will be fundamental to the future of stroke care. “It is very important that we are continuously evaluating our path, our outcomes, and comparing techniques to each other,” he says, “It is a rapidly evolving field, so as new techniques and new developments come about, as they naturally will, it is critical that we continuously self-evaluate as we go along.”

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. 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.