Clinical Neuroradiology

, Volume 28, Issue 3, pp 327–338 | Cite as

Maximizing First-Pass Complete Reperfusion with SAVE

  • Volker MausEmail author
  • Daniel Behme
  • Christoph Kabbasch
  • Jan Borggrefe
  • Ioannis Tsogkas
  • Omid Nikoubashman
  • Martin Wiesmann
  • Michael Knauth
  • Anastasios Mpotsaris
  • Marios Nikos Psychogios
Original Article



Endovascular techniques for treatment of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) have advanced in recent years. We report a multicenter experience using a combined aspiration and stent retriever technique for mechanical thrombectomy (MT).


We retrospectively analyzed 32 consecutive MT patients using a novel, combined approach of Stent retriever Assisted Vacuum-locked Extraction (SAVE) by 3 operators at 3 stroke centers. Primary endpoint was successful first-pass reperfusion with a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3. Secondary endpoints were number of passes, time from groin puncture to reperfusion, embolization to new territories (ENT), postinterventional symptomatic intracranial hemorrhage (sICH) and clinical outcome at discharge.


First-pass mTICI 3 reperfusion was achieved in 23 out of 32 patients (72%) with a mean groin puncture to reperfusion time of 36.0 min ± 15.8 and mTICI 3 was accomplished in 25 out of 32 cases (78%) with a maximum of 3 attempts. Successful reperfusion (mTICI ≥ 2b) was achieved in all patients (100%) with a mean time from groin puncture to reperfusion of 44.5 min ± 25.8 and an average of 1.2 ± 0.7 attempts. The rate of ENT was 0% and 1 patient with sICH after MT died on postoperative day 4. At discharge, the median National Institutes of Health Stroke Scale (NIHSS) score was 4 (range 0−17) and favorable neurological outcome by the modified Rankin score (mRS ≤ 2) was achieved in 19 out of 32 patients (59%).


SAVE is fast and appears to be very effective in terms of first-pass complete reperfusion in patients with LVO.


Acute ischemic stroke Large vessel occlusion Mechanical thrombectomy SAVE 


Compliance with ethical guidelines

Conflict of interests

V. Maus reports minor travel grants from Stryker Neurovascular. D. Behme reports minor travel grants from Stryker Neurovascular. C. Kabbasch reports minor travel grants from Stryker Neurovascular. J. Borggrefe has nothing to disclose. I. Tsogkas has nothing to disclose. O. Nikoubashman has nothing to disclose. M. Wiesmann reports grants and personal fees from Stryker Neurovascular, non-financial support from Covidien, non-financial support from Penumbra, non-financial support from Microvention/Terumo. M. Knauth has nothing to disclose. A. Mpotsaris reports personal fees for consultancy from Neuravi and Penumbra. M.N. Psychogios has nothing to disclose.

Ethical standards

According to the guidelines of the respective local ethics committees, no approval was necessary for this anonymous study, which was conducted in accordance to the Declaration of Helsinki (in its current revised form). Due to the retrospective nature of the study informed consent from participants was deemed unnecessary. Consent was obtained from any patients identifiable from images or other information in the manuscript.

Supplementary material

Illustrative video case of SAVE technique


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Volker Maus
    • 1
    Email author
  • Daniel Behme
    • 2
  • Christoph Kabbasch
    • 1
  • Jan Borggrefe
    • 1
  • Ioannis Tsogkas
    • 2
  • Omid Nikoubashman
    • 3
  • Martin Wiesmann
    • 3
  • Michael Knauth
    • 2
  • Anastasios Mpotsaris
    • 1
  • Marios Nikos Psychogios
    • 2
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital CologneCologneGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity of GöttingenGöttingenGermany
  3. 3.Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital of AachenAachenGermany

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