The SAVE Technique
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The stent retriever assisted vacuum-locked extraction (SAVE) technique was introduced as an effective thrombectomy method in stroke patients suffering from intracranial large vessel occlusion (LVO). This article presents our multicenter, large-scale experience with SAVE.
The study involved a retrospective core team analysis of 200 patients undergoing mechanical thrombectomy using the SAVE technique due to intracranial LVO at 4 German centers. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints were the number of passes, time from groin puncture to reperfusion, embolization to new territories (ENT), postinterventional symptomatic intracranial hemorrhage (sICH), and favorable outcome at discharge, defined as a modified Rankin Scale (mRS) score ≤ 2.
The median age was 78 years (interquartile range IQR 68–85). Median National Institutes of Health stroke scale (NIHSS) at admission was 16 (IQR 12–20). Occlusions sites were: internal carotid artery (ICA-T) in 39/200 (19.5%), M1 in 126/200 (63%), M2 in 30/200 (15%), and others in 5/200 (2.5%) cases. The primary endpoints were documented in 114/200 (57% first pass mTICI 2c or 3) and 154/200 (77% overall mTICI 2c or 3) patients, respectively. The overall median time from groin puncture to reperfusion was 34 min (IQR 25–52) with a median of 1 (IQR 1–2) attempts. An ENT was observed in 3 patients (1.5%) and the rate of sICH was 2.6%. The rate of successful reperfusion (mTICI ≥ 2b) on final angiograms was 95%. At discharge, 73/200 (36.5%) patients revealed a favorable outcome.
Mechanical thrombectomy using the SAVE technique seems to be effective, fast and safe. First-line use of SAVE leads to high rates of complete and near complete reperfusion.
KeywordsIschemic stroke Mechanical thrombectomy Stent-retriever SAVE Large vessel occlusion
Compliance with ethical guidelines
Conflict of interest
D. Behme Consultant: Phenox; speakers fees: Siemens, Styker, Penumbra. M. Wiesmann worked as a consultant and received reimbursement for lectures or travel support: Stryker Neurovascular; received reimbursement for lectures or travel support: Bracco Imaging, Medtronic, Siemens Healthcare, Abbott. A. Mpotsaris consultancy (modest fees): Neuravi, Penumbra, Sequent Medical. M.-N. Psychogios: travel grant, fees: Styker, Phenox, Penumbra, Acandis, Siemens. V. Maus, S. Henkel, A. Riabikin, C. Riedel, I. Tsogkas, A.C. Hesse, N. Abdullayev and O. Jansen declare that they have no competing interests.
According to the guidelines of the respective local ethics committees, ethical approval was given when necessary (University Medical Center Göttingen) for this anonymous retrospective study, which was conducted in accordance to the Declaration of Helsinki. A patient’s consent for treatment was obtained according to the individual institutional guidelines. Due to the retrospective nature of the study additional informed consent was deemed unnecessary.
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