CATCH : Mechanical Thrombus Retriever

Neuroradiology by BALT Extrusion

What is a Stroke ?

Stroke is a sudden interruption in the blood supply of the brain

ISCHEMIC STROKE HEMORRHAGIC STROKE

The blockage is caused by an abrupt blockage of arteries leading to the brain

The stroke is caused by bleeding into brain tissue when a blood vessel or an aneurysm bursts

With 20.000.000 cases per year, strokes are the 3rd cause of death in developed

countries and a major cause of disability

85% 15%

blood clotAtheroscleroti

c plaque

An ischemic stroke has to be managed very quickly after the crisis by fibrinolysis therapy and/or embolectomy

H0 to H+3

H+3 to H+8

Intravenous fibrinolysis therapy

Mechanical Thrombo Embolectomy

A anti platelets is injected through patient vascular system to dissolve the clot

The clot is mechanically removed thanks to a mechanical thrombus retriever with intravascular access

Due to the short time limit, less than 3% patients get an intravenous fibrinolysis therapy

Brain attack

H+3

For fibrinolysis contraindicated patients

Up to now, mechanical thrombus retrievers were not very efficient…

MERCITM (Concentric Medical)• « corkscrew » system• Less than 50% success rate

IN-TIMETM (Boston Scientific)• Dormia system• too stiff for intracranial use

LASSOO (BALT Extrusion, Boston Sc., …)• initially designed for coil retrieval• high risk of clot fragmentation

…so fibrinolytic therapy remained the most secure treatment

BALT designed the CATCH, a new system based on the technology developed for the LEO intracranial stent

a 16-wire self-expandable basketallowing for a clot retrieval

with a reduced risk of fragmentation

CATCH thrombus retrieval system combines good navigation and excellent visualization

2,4F braided catheterVASCO+21

CATCH coupled to a pusher

Ø4m

m

18mm Pusher’s ORX marker

1 distal ORX marker

4 ORX markers for CATCH opening visualization

TIMI grade flow ≥ 2

TIMI grade flow ≥ 2

Complementary in situ fibrinolysis

through VASCO+21max. 0,9mg/kg rtPA*

THROMBO-EMBOLECTOMY GUIDELINES WITH THE CATCH DEVICE

TIMI grade flow ≥ 2

1st CATCH procedure

TIMI grade flow ≥ 2

In situ fibrinolysisthrough VASCO+21

20mg rtPA*

2nd, possibly 3rd CATCH procedure

4th, possibly 5th CATCH procedure

*only if in situ fibrinolysis procedure is recognized by local health authorities and if patient has no contraindication to fibrinolysis

PER MEDICATION: heparin bolus intravenous injection (50 Ul/kg) at the beginning

If you carefully follow CATCH instructions for use as

described hereafter, the same CATCH system can be used

for these 5 procedures

CATCH procedure is detailed here after

CATCH resheathing

If needed*

Clot & CATCH retrieval

CATCH system has to used according following procedure

CATCH procedure

Positioning & deployment

*If TIMI ≥ 2 after the first CATCH procedure, the system can be resheathed to be used for another procedure,

and so on up to 5 procedures

CATCH Procedure (1/2)Positioning and deployment

Use a 8F guiding catheter (ENVOY8F for example) or a CORAIL8F+ or a long introducer (IVA6F80)

Run the VASCO+21 catheter through the thrombus and position it at least at 2 cm downstream from the thrombus

After removing the microguidewire, introduce the CATCH into VASCO+21 and push it until it reaches the tip of the catheter

2 cm mini

VASCO+21

Microguidewire

ORX CATCH

ORX VASCO

ORX Pusher Deploy the CATCH downstream out of the VASCO+21 from the thrombus by pulling the catheterThe radiopaque marker of the pusher should be at least 1cm from that of the VASCO+21

Do not push the CATCH out of the catheter: its tip may damage the artery

Using a CORAIL8F will allow to inflate the balloon to facilitate clot retrieval

CATCH resheathing

Clot & CATCH retrieval

Positioning & deployment

CATCH Procedure (2/2)Clot and CATCH retrieval

If you use a CORAIL8F, inflate the balloon

Slightly pull back, with pauses, the assembly CATCH+Catheter to move the thrombus down to the guiding catheter,

Do not try to pull back the CATCH into the VASCO+21 catheter

When approaching the guiding catheter, turn off its perfusion.

Get out the assembly CATCH+Catheter through the guiding catheter

Suck the guiding catheter inner lumen (blood and clot), with a syringe 20ml minimum

Turn on the guiding catheter perfusion

Clean carefully the CATCH in a physiological serum or sterile water bowl and/or under a syringe jet

CATCH resheathing

Clot & CATCH retrieval

Positioning & deployment

CATCH system can be re-used up to 5 times if the resheathing procedure is strictly

respected

Trying to resheath the CATCH without the hub will destroy the basket

A HUB PACKED WITH THE CATCH ENABLES IT RESHEATHING

Before resheathing the CATCH, carefully check if its basket is not damaged

CATCH resheathing

Clot & CATCH retrieval

Positioning & deployment

A hub is packed with the CATCH to allow its correct resheathing

2Insert the proximal part of the pusher inside the

proximal hole of the resheathing hub

3

4

1 Take the basket + pusher out of the VASCO+21 by its distal tip

CATCH

Pusher BasketVASCO+21

Resheathing hub

Introducing sheath Insert the distal part of the introducing sheath

on the proximal part of the pusher

Introducing sheath Resheathing hub CATCH

1 2

3 4

Gently pull on the pusher until the basket passes through the hub inside the sheath

CATCH resheathing

Clot & CATCH retrieval

Positioning & deployment

Cases already done show a high success rate

for the CATCH system

Occlusion of the medium cerebral artery(Pr René Chapot, Limoges - France)CASE #1

Occlusion of the basilar artery(Pr René Chapot, Limoges - France)CASE #2

EXAMPLES OF CASES EXAMPLES OF CASES

Occlusion of the medium and anterior cerebral arteries(Pr Schroth and Dr Remonda, Bern - Switzerland)CASE #3

CASE #1 : Occlusion of the medium cerebral artery(Pr René Chapot, Limoges - France)

BEFORE

microguidewire

Vasco+21

CATHETER POSITIONING

Vasco+21CATCH

CATCH POSITIONING

CASE #1 : Occlusion of the medium cerebral artery(Pr René Chapot, Limoges - France)

Vasco+21

CLOT RETRIEVAL

CATCH

AFTER RETRIEVED CLOT

CASE #2 : Occlusion of the basilar artery(Pr René Chapot, Limoges - France)

BEFORE CATCH POSITIONING

CATCH

Vasco+21

CATCH OPENNING

CATCH

CASE #2 : Occlusion of the basilar artery(Pr René Chapot, Limoges - France)

CLOT RETRIEVAL AFTER RETRIEVED CLOT

CASE #3 : Occlusion of the medium and anterior cerebral arteries

(Pr Schroth and Dr Remonda, Bern - Switzerland)

BEFORE CATCH POSITIONING

CATCH

Vasco+21

CASE #3 : Occlusion of the medium and anterior cerebral arteries

(Pr Schroth and Dr Remonda, Bern - Switzerland)

AFTER FIRST USE (Anterior Cerebral) CLOT RETRIEVED

Frequently Asked QuestionsWhich guiding catheter do we use with a CATCH ?Minimum guiding catheter diameter is 6Fbut the more the diameter is high, the less there is clot fragmentation risks during the retrieval. We would advise a 8F guiding catheter. CORAIL8F is particularly indicated since the balloon inflation allows a very efficient thrombo-aspiration in addition to mechanical retrieval.

Is one CATCH use sufficient to unblock an artery ?In some cases, one use allow to completely retrieve the clot however, it is often necessary to go through several times, up to five times. This can be done with the same device, if the CATCH is well resheathed according to the detailed resheathing procedure and is washed according to IFU. How do we have to wash the CATCH between two uses ?You should shake the CATCH basket in a physiological serum bath. If some pieces remain in the basket, it is possible to use the pressure of a syringe jet to get rid of them.

Do you have or Can you use fibrinolysis during CATCH use ?Yes. Within the European multicentric study we are presently conducting, the protocol holds that, if the artery is not completely unblocked after the CATCH first use, 20m rtPA should be locally injected with the microcatheter. After the third use, if the artery is not still completely unblocked, a complementary rtPA local injection can be done with a total maximum of 0,9mg/kg rtPA.

In which arteries can the CATCH be used ?CATCH can be used in any intracranial artery which diameter is at least 2mm. For peripheral and venous sinus use, we developed another reference, CATCH9, with a bigger diameter from 5 to 10mm.

What is the CATCH success rate ?We do not have yet any statistics. However, users’ feedbacks make us think that it will be far higher than MERCI success rate. Two multicentric studies are under way to get a more precise estimation of this device success rate. Our first feedbacks, with experienced users following the procedure described here above, give around 80% success rate.

Thank you!

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