Aspiration-based extraction technique beneficial for AF, peripheral arterial occlusions

HOLLYWOOD, Fla. — Patients with atrial fibrillation experienced good outcomes after treatment with an aspiration-based extraction technique using a mechanical thrombectomy device for peripheral arterial occlusions, according to a subset analysis from the PRISM trial.

This subanalysis of the single-arm, multicenter, retrospective PRISM trial — which showed that the power aspiration-based extraction technique (Xtract) using the Indigo Aspiration System (Penumbra) was safe and effective for front-line or secondary treatment of peripheral arterial occlusions in patients with a TIMI score of 0 to 1 — focused on the patients with AF enrolled in the study.

The primary endpoints included vessel patency immediately after extraction with the aspiration-based technique and any other endovascular procedure measured by TIMI score and the rate of procedural serious adverse events within 24 hours after treatment.

Results of the subanalysis were presented by James Benenati, MD, from the Miami Cardiac and Vascular Institute in Florida, at the International Symposium on Endovascular Therapy.

Among the 12 patients with AF, as compared with all patients enrolled in the study (n = 79), there was a higher proportion of women (66.7% vs. 41.8%) and a lower proportion of patients with diabetes (9.1% vs. 33%). Brachial occlusions were also more common among those with AF compared with all patients enrolled (8.3% vs. 1.3%).

The aspiration-based extraction technique was used as front-line treatment in 58.3% of patients with AF and 49.4% of all patients. It was also used secondary to failure from thrombolytics in 16.7% patients with AF and 15.2% of all patients as well as secondary to failure from both thrombolytics and mechanical thrombectomy in 16.7% of patients with AF and 16.5% of all patients. However, the extraction technique was used secondary to failure from other mechanical therapy less often in patients with AF compared with all patients (8.3% vs. 19%).

The overall rate of successful revascularization to TIMI 2 to 3 with the aspiration-based extraction technique was 83.3% in patients with AF and 87.2% in all patients. When used as front-line treatment, the rates of successful revascularization to TIMI 2 to 3 were 71.4% in patients with AF and 79.5% in all patients. When used as secondary treatment, the rates of successful revascularization to TIMI 2 to 3 were 100% and 92.5%, respectively.

The rates of severe adverse events within 24 hours were 8.3% for patients with AF and 8.9% for all patients, with no events being device-related.

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“Using the Xtract technique with the Penumbra Indigo System was shown to be safe and effective in AF patients with underlying peripheral arterial occlusion. Patients fared well when used as front-line therapy or as salvage technique when other endovascular techniques or thrombolytics had failed,” Benenati said during his presentation. “We’d like to see prospective trials in the future, and new-generation catheters and pumps may facilitate aspiration potential.” – by Melissa Foster

Reference:

Benenati JF. Efficacy of XTRACT on atrial fibrillation patients with peripheral arterial disease: Subset analysis from PRISM. Presented at: the International Symposium on Endovascular Therapy (ISET); Jan. 27-30, 2019; Hollywood, Fla.

Disclosure: Benenati reports he consults for and has stock in Penumbra.