1. CATCH : Mechanical Thrombus Retriever
Neuroradiology by BALT Extrusion
CATCH : Mechanical Thrombus Retriever

2. Atherosclerotic plaque
What is a Stroke ?
Stroke is a sudden interruption in the blood supply of the brain
85%
15%
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
blood clot
Atherosclerotic plaque
Now, how to use the LEO stent: it is a 3 steps process:
With cases per year,
strokes are the 3rd cause of death in developed countries and a major cause of disability

3. An ischemic stroke has to be managed very quickly after the crisis by fibrinolysis therapy and/or embolectomy
Intravenous fibrinolysis therapy
A anti platelets is injected through patient vascular system to dissolve the clot
H0 to H+3
H+3
Brain attack
H+3 to H+8
For fibrinolysis contraindicated patients
Now, how to use the LEO stent: it is a 3 steps process:
Mechanical Thrombo Embolectomy
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

4. Up to now, mechanical thrombus retrievers were not very efficient…
LASSOO
(BALT Extrusion, Boston Sc., …)
initially designed for coil retrieval
high risk of clot fragmentation
MERCITM (Concentric Medical)
« corkscrew » system
Less than 50% success rate
IN-TIMETM (Boston Scientific)
Dormia system
too stiff for intracranial use
I will first present you the LEO stent itself, from a technical point of view.
Then, we will see what kind of use the LEO is designed for
And I will finish by a description of the implantation process, for which there are some specific details that have to be taken into account.
…so fibrinolytic therapy remained the most secure treatment

5. Then, we will see what kind of use the LEO is designed for
BALT designed the CATCH, a new system based on the technology developed for the LEO intracranial stent
I will first present you the LEO stent itself, from a technical point of view.
Then, we will see what kind of use the LEO is designed for
And I will finish by a description of the implantation process, for which there are some specific details that have to be taken into account.
a 16-wire self-expandable basket
allowing for a clot retrieval
with a reduced risk of fragmentation

6. 4 ORX markers for CATCH opening visualization
CATCH thrombus retrieval system combines good navigation and excellent visualization
2,4F braided catheter
VASCO+21
CATCH
coupled to a pusher
4 ORX markers for CATCH opening visualization
I will first present you the LEO stent itself, from a technical point of view.
Then, we will see what kind of use the LEO is designed for
And I will finish by a description of the implantation process, for which there are some specific details that have to be taken into account.
Ø4mm
18mm
Pusher’s ORX marker
1 distal ORX marker

7. THROMBO-EMBOLECTOMY GUIDELINES WITH THE CATCH DEVICE
PER MEDICATION: heparin bolus intravenous injection (50 Ul/kg) at the beginning
1st CATCH procedure
CATCH procedure is detailed here after
If you carefully follow CATCH instructions for use as described hereafter, the same CATCH system can be used for these 5 procedures
TIMI grade flow ≥ 2
In situ fibrinolysis
through VASCO+21
20mg rtPA*
TIMI grade flow ≥ 2
2nd, possibly 3rd
CATCH procedure
I will first present you the LEO stent itself, from a technical point of view.
Then, we will see what kind of use the LEO is designed for
And I will finish by a description of the implantation process, for which there are some specific details that have to be taken into account.
TIMI grade flow ≥ 2
Complementary
in situ fibrinolysis
through VASCO+21
max. 0,9mg/kg rtPA*
TIMI grade flow ≥ 2
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

8. CATCH system has to used according following procedure
CATCH procedure
Positioning & deployment
Clot & CATCH retrieval
CATCH resheathing
If needed*
*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

9. CATCH Procedure (1/2) Positioning and deployment
CATCH resheathing
Clot & CATCH retrieval
Positioning & deployment
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
Deploy the CATCH downstream out of the VASCO+21 from the thrombus by pulling the catheter
The radiopaque marker of the pusher should be at least 1cm from that of the VASCO+21
ORX CATCH
ORX VASCO
ORX Pusher
Now, how to use the LEO stent: it is a 3 steps process:
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

10. CATCH Procedure (2/2) Clot and CATCH 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
Now, how to use the LEO stent: it is a 3 steps process:
Clean carefully the CATCH
in a physiological serum or sterile water bowl and/or under a syringe jet

11. CATCH system can be re-used up to 5 times if the resheathing procedure is strictly respected
CATCH resheathing
Clot & CATCH retrieval
Positioning & deployment
Before resheathing the CATCH, carefully check if its basket is not damaged
Trying to resheath the CATCH without the hub will destroy the basket
A HUB PACKED WITH THE CATCH ENABLES IT RESHEATHING

12. A hub is packed with the CATCH to allow its correct resheathing
CATCH resheathing
Clot & CATCH retrieval
Positioning & deployment
A hub is packed with the CATCH to allow its correct resheathing 1
CATCH
Take the basket + pusher out of the VASCO+21 by its distal tip
VASCO+21
Pusher
Basket 2
Resheathing hub
Insert the proximal part of the pusher inside the proximal hole of the resheathing hub 3
Introducing sheath
Insert the distal part of the introducing sheath on the proximal part of the pusher 4 1 2
Gently pull on the pusher until the basket passes through the hub inside the sheath
Introducing sheath
Resheathing hub
CATCH 3 4

13. Cases already done show a high success rate for the CATCH system
EXAMPLES OF CASES
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
Occlusion of the medium and anterior cerebral arteries
(Pr Schroth and Dr Remonda, Bern - Switzerland)
CASE #3

14. CASE #1 : Occlusion of the medium cerebral artery (Pr René Chapot, Limoges - France)
BEFORE
microguidewire
Vasco+21
CATHETER POSITIONING
Vasco+21
CATCH
CATCH POSITIONING

15. CASE #1 : Occlusion of the medium cerebral artery (Pr René Chapot, Limoges - France)
Vasco+21
CLOT RETRIEVAL
CATCH
AFTER
RETRIEVED CLOT

16. CASE #2 : Occlusion of the basilar artery (Pr René Chapot, Limoges - France)
BEFORE
CATCH POSITIONING
CATCH
Vasco+21
CATCH OPENNING
CATCH

17. CASE #2 : Occlusion of the basilar artery (Pr René Chapot, Limoges - France)
CLOT RETRIEVAL
AFTER
RETRIEVED CLOT

18. CASE #3 : Occlusion of the medium and anterior cerebral arteries (Pr Schroth and Dr Remonda, Bern - Switzerland)
BEFORE
CATCH POSITIONING
CATCH
Vasco+21

19. AFTER FIRST USE (Anterior Cerebral)
CASE #3 : Occlusion of the medium and anterior cerebral arteries (Pr Schroth and Dr Remonda, Bern - Switzerland)
AFTER FIRST USE (Anterior Cerebral)
CLOT RETRIEVED

20. Frequently Asked Questions
Which 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.

21. Thank you!