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Power.
Combined.

Combination Therapy for AIS

Aim for first pass success1
with a combination of compatible2 tools.​


See the power of combination therapy

When you have that power, you can combat procedural variability and feel more confident to deliver positive procedural outcomes.†,1,3,4

Achieve a higher rate of first pass success.5,6

Combination as first-line technique

Combination therapy has been shown to significantly achieve‡: 

  • Higher successful recanalization at first pass and at the end of the procedure
  • Shorter puncture-to-reperfusion time
  • Fewer number of passes
% first pass effect (FPE)7 (mTICI 2c-3)
p<0.001
combination
Puncture-to-reperfusion time6
(median) p<0.001
puncture-to-reperfusion

Combination as bailout

A multicenter analysis of nearly 3,000 patients found switching to combination therapy after a failed first aspiration pass resulted in higher reperfusion rates than continuing with aspiration alone.7 Even when you do not start with the combined approach, consider switching as early as second pass to increase your chances of eTICI 2c-3.7

Download the synopsis

Medtronic combination therapy real-world evidence

Summary

The global Innovative Neurovascular Product Survelliance Registry-Accute Ischemic Stroke (INSPIRE-S registry) of patients treated with the Solitaire™ revascularization device combined with a React™ catheter or other aspiration catheter evaluated the rate of good clinical outcomes (mRS 0-2 at 90 days or mRS ≤ pre-stroke mRS score).1

Method

The prospective, core-lab and clinical events committee (CEC)-adjudicated registry included 397 patients who underwent endovascular thrombectomy using the Solitaire™ device with an aspiration catheter (React™ 68/71 catheter 76% of the time) between May 2020 and December 2022.1


Results

  • Good clinical outcome – 56.4%
  • Final eTICI ≥2b50 – 93.4%
  • First pass eTICI ≥2b50 – 61.1%
  • sICH§ – 1.5%

 

Decrease procedural variability.†,3,4

Success of endovascular thrombectomy with a single device may be influenced by:  

  • Vessel anatomy
  • Clot composition and length
  • Angle of interaction between the aspiration catheter and clot3


With combination therapy, maximize procedural success by complementing the strengths of the stent retriever with the aspiration catheter to minimize the influence of a single variable.

Minimize distal embolization5,8

Combination therapy was found to be the most efficient method for reducing the rate of clot fragmentation for hard fragment-prone clots.8 

Aspiration-alone doubled the risk of soft elastic clot fragmentation compared to the stent retriever-alone technique.7-8

Minimize the possibility of clot disruption by combining the stent retriever with the aspiration catheter.5

Facilitate smooth navigation through tortuous vasculature9

With combination therapy, use the stent retriever as an anchor to promote smooth navigation of the aspiration catheter to reach the occlusion site, improving reliability of tracking when positioning the aspiration catheter closer to the face of the clot.9

Compatibility and dependability. Combined.

Trust in reliable10, compatible2 tools to combat variability.

 

  • The Solitaire™ X Device is a clinically proven11 stent retriever with a unique overlapping parametric design that provides dynamic clot integration12 and differentiated radial outward force.13

  • The React™ Catheter is designed for trackability with the COBRA (COil + BRAid) technology8 and durability of nitinol to support the Solitaire™ X device.14

  • The Phenom™ 21/27 Catheters with 160cm length are optimized to deliver14 all sizes of the Solitaire™ X device providing smooth deliverability with a low clot-crossing profile.

The use of the Solitaire™ Device with the React™ Catheter results in high rates of FPE.1
Solitaire™ X Revascularization Device
Medtronic React™ catheter, Soitaire™ X device, and Phenom™ 21/27 catheters annotated

† Compared to aspiration-alone technique
‡ Compared to aspiration-alone and stent retriever-alone techniques
§ Symptomatic Intracranial Hemorrhage (CEC-adjudicated)

1

Ribó M, Möhlenbruch M, Cognard C, Sanjeev N, Mordasini P. Combination therapy using Solitaire™ revascularization device and primarily the React™ catheter in mechanical thrombectomy: Experience from INSPIRE-S registry. Poster at: International Stroke Conference; February 7-9, 2024; Phoenix, AZ.

2

Data on file; TR-NV14973B, TR-NV16168A, D00033351A, TR-NV15999B, TR-NV15399A..

3

Bernava G, Rosi A, Boto J, et al. Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot. J Neurointerv Surg. 2020;12(4):396–400. 

4

Liu Y, Gebrezgiabhier D, Zheng Y, et al. Arterial collapse during thrombectomy for stroke: Clinical evidence and experimental findings in human brains and in vivo models. AJNR Am J Neuroradiol. 2022;43(2):251–257.

5

Diana F, Vinci SL, Ruggiero M, et al. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: A multicenter experience. J Neurointerv Surg. 2022;14(7):666–671.

6

Okuda T, Arimura K, Matsuo R, et al. Efficacy of combined use of a stent retriever and aspiration catheter in mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg. 2022;14(9):892–897.

7

Martins PN, Nogueira RG, Tarek MA, et al. Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: Should theapproach change and when? J Neurointerv Surg. Published online April 4, 2024. doi:10.1136/jnis-2024–021545

8

Chueh JY, Puri AS, Wakhloo AK, Gounis MJ. Risk of distal embolization with stent retriever thrombectomy and ADAPT. J Neurointerv Surg. 2016;8(2):197–202.

9

Li J, Tomasello A, Requena M, et al. Trackability of distal access catheters: an in vitro quantitative evaluation of navigation strategies. J Neurointerv Surg. 2023;15(5):496–501. 

10

Data on file; TR-NV15436C, D00272862C, D00344794B, TR-NV15519A, TR-NV15666A, TR-NV15346C, TR- NV14704A-1, TR-NV14443A, TR-NV14704A, TR-NV15965A, D00292166B

11

Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–1731.

12

Data on file; TR-NV13807A, D00419703D, TR-NV15666A, D00324045A.

13

Data on file; D00419703D, D00324045A, TR-NV12180A.

14

Data on file; TR-NV16168A, D00033351A

  • React™ Catheter, Licensed as REACT 68 CATHETER, REACT 71 CATHETER.